Provider Demographics
NPI:1871770669
Name:BRAESWOOD FAMILY MEDICAL CLINIC
Entity type:Organization
Organization Name:BRAESWOOD FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:MBAWUIKE
Authorized Official - Last Name:AHAM-NEZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MPH
Authorized Official - Phone:713-776-3300
Mailing Address - Street 1:8527 W. BELLFORT AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2207
Mailing Address - Country:US
Mailing Address - Phone:713-776-3300
Mailing Address - Fax:713-776-3302
Practice Address - Street 1:8527 W. BELLFORT AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2207
Practice Address - Country:US
Practice Address - Phone:713-776-3300
Practice Address - Fax:713-776-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4146261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care