Provider Demographics
NPI:1730597527
Name:TEXAS XPRESS CARE CLINIC, LLC
Entity type:Organization
Organization Name:TEXAS XPRESS CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-421-9519
Mailing Address - Street 1:3708 W DAVIS ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1865
Mailing Address - Country:US
Mailing Address - Phone:936-760-8500
Mailing Address - Fax:936-760-8502
Practice Address - Street 1:3708 W DAVIS ST
Practice Address - Street 2:SUITE H
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1865
Practice Address - Country:US
Practice Address - Phone:936-760-8500
Practice Address - Fax:936-760-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty