Provider Demographics
NPI:1053888644
Name:TMNP HEALTH SERVICES LLC
Entity type:Organization
Organization Name:TMNP HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:936-672-2961
Mailing Address - Street 1:154 HARLEY DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8812
Mailing Address - Country:US
Mailing Address - Phone:936-672-2961
Mailing Address - Fax:
Practice Address - Street 1:154 HARLEY DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-8812
Practice Address - Country:US
Practice Address - Phone:936-672-2961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care