Provider Demographics
NPI:1255773123
Name:SPIRIT OF TEXAS FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:SPIRIT OF TEXAS FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:YASMEEN
Authorized Official - Last Name:SADOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-806-8729
Mailing Address - Street 1:15200 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3845
Mailing Address - Country:US
Mailing Address - Phone:614-806-8729
Mailing Address - Fax:
Practice Address - Street 1:15200 SOUTHWEST FWY
Practice Address - Street 2:SUITE 180
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3845
Practice Address - Country:US
Practice Address - Phone:614-806-8729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-21
Last Update Date:2013-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2163261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care