Provider Demographics
NPI:1902584865
Name:TOMBALL HEALTH MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:TOMBALL HEALTH MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-205-7085
Mailing Address - Street 1:11023 NORTHPOINTE BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2340
Mailing Address - Country:US
Mailing Address - Phone:281-205-7085
Mailing Address - Fax:877-288-1193
Practice Address - Street 1:11023 NORTHPOINTE BLVD STE F
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-2340
Practice Address - Country:US
Practice Address - Phone:281-205-7085
Practice Address - Fax:877-288-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health