Basic Information
| Provider Information | |||||||||
| NPI: | 1972883841 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CYMED TOMBALL ,PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | AFC URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5943 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234710943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3467045400 | ||||||||
| FaxNumber: | 4135400159 | ||||||||
| Practice Location | |||||||||
| Address1: | 10850 LOUETTA RD | ||||||||
| Address2: | STE 1500 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770703533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813202338 | ||||||||
| FaxNumber: | 2813202349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GREWAL | ||||||||
| AuthorizedOfficialFirstName: | HERMANJEET | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2813202338 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N0216 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.