Provider Demographics
NPI:1154894822
Name:ADA FAMILY HEALTH CLINIC PLLC
Entity type:Organization
Organization Name:ADA FAMILY HEALTH CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TASHIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-669-9409
Mailing Address - Street 1:8191 SOUTHWEST FWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1700
Mailing Address - Country:US
Mailing Address - Phone:835-669-9409
Mailing Address - Fax:718-362-1651
Practice Address - Street 1:8191 SOUTHWEST FWY STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1700
Practice Address - Country:US
Practice Address - Phone:832-669-9409
Practice Address - Fax:832-669-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-05
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306390414Medicaid