1386828648 NPI number — FELECIA I. JACKSON/MEJA HEALTH CARE SERVICES

Table of content: (NPI 1386828648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386828648 NPI number — FELECIA I. JACKSON/MEJA HEALTH CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FELECIA I. JACKSON/MEJA HEALTH CARE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386828648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22136 WESTHEIMER PARKWAY SUITE 344
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77450-8296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-463-9909
Provider Business Mailing Address Fax Number:
281-463-9909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5115 MANORHAVEN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77084-2392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-463-9909
Provider Business Practice Location Address Fax Number:
281-463-9909
Provider Enumeration Date:
12/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
FELECIA
Authorized Official Middle Name:
IRIS
Authorized Official Title or Position:
DIRECT OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
281-463-9909

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  11608429 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: 683656 (R.N.) , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)