Brazosport Pediatric and Family Clinic PLLC
Organization Active NPI Family Medicine Physician · Angleton, TX
NPI 1467014753 · NPPES record last updated Jan 23, 2024
Key facts
- NPI
- 1467014753
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BRAZOSPORT PEDIATRIC AND FAMILY CLINIC PLLC
- Practice address
- 222 N Velasco St Ste a
Angleton, TX 77515-4576 - Phone
- (979) 300-0032
- Fax
- (979) 297-9096
- NPI assigned
- Jul 8, 2019
- Organization subpart
- No
Authorized official
- Name
- Lauren Deann King
- Title
- Owner
- Phone
- (979) 300-0032
Practitioners 2
-
Lauren Deann King, NP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2176446 | Brazosport Pediatric and Family Clinic | Certificate of waiver | Dec 15, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190809000295 | TX | Part B Supplier - Clinic/Group Practice | 0042547366 |
Receives reassigned benefits from 2 practitioners Practice locations: Angleton, TX |
National Provider Directory
Locations
222 S Velasco St
Ste A
Angleton, TX 77515
Phone (979) 848-8000
222 N Velasco St
Ste A
Angleton, TX 77515
Phone (979) 300-0032
135 Oyster Creek Dr
Ste W
Lake Jackson, TX 77566
Phone (979) 299-1200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
222 N Velasco St Ste a
Angleton, TX 77515-4576
Mailing address
222 N Velasco St Ste a
Angleton, TX 77515-4576
Phone (979) 300-0032
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740052984 | Other | TX | NPI |
| 1457645806 | Other | TX | NPI |
Other providers in Angleton, TX
- Brazoria County Imaging Center
- Brazoria County Imaging Center on Brazos, Inc.
- Brazoria County Obstetrics and Gynecology, PLLC
- Brazoria County Surgery Center, LLC
- Brazoria Sleep Experts
- Brent L. Mixon, OD, LLC
- Chelsea Lynn Brossette
- Euraka Monique Brown
- Monica A Brown
- Susan Dianne Brown
All providers in Angleton, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2024. 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.