Providence Mission Ministry LLC
Organization Active NPI Primary Care Clinic/Center · Coldspring, TX
NPI 1366988412 · NPPES record last updated Mar 8, 2020
Key facts
- NPI
- 1366988412
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- PROVIDENCE MISSION MINISTRY LLC
- Practice address
- 21 Alpine St
Coldspring, TX 77331-8058 - Phone
- (936) 647-2227
- Fax
- (936) 647-2202
- NPI assigned
- Jan 12, 2017
- Organization subpart
- No
Authorized official
- Name
- Mrs. Jennifer Nguyen
- Title
- Business Account Manager
- Phone
- (281) 774-8785
Practitioners 1
-
Tri Minh Le, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2131012 | Providence Family Care | Certificate of waiver | May 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170612000244 | TX | Part B Supplier - Clinic/Group Practice | 0345518619 |
Receives reassigned benefits from 1 practitioner Practice locations: Coldspring, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
21 Alpine St
Coldspring, TX 77331-8058
Mailing address
PO Box 1293
New Caney, TX 77357-1293
Phone (281) 774-8785
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 371798501 | Medicaid | TX |
Other names
- Providence Family Care
Other providers in Coldspring, TX
- Maria Guadalupe Navarro Elias
- Next Step Behavioral Houston
- Our House of Hope 2
- Peter S Jerome MD PLLC
- Philip R. Wisiackas, M.D., P.a.
- Rayfield Jefferson
- Janet Kristine Sanve
- Senior Citizens of San Jacinto County
- Renee Lee Sides
- Smith Advocacy Services
All providers in Coldspring, TX · Primary Care Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.