Provider Demographics
NPI:1447671086
Name:G.LLC
Entity type:Organization
Organization Name:G.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-484-2308
Mailing Address - Street 1:7322 THUROW ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-3721
Mailing Address - Country:US
Mailing Address - Phone:832-484-2308
Mailing Address - Fax:832-201-9729
Practice Address - Street 1:7322 THUROW ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-3721
Practice Address - Country:US
Practice Address - Phone:832-484-2308
Practice Address - Fax:832-201-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-28
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1Medicaid
TX1Medicare PIN