1265800940 NPI number — CLINIC AT SAMSONS

Table of content: (NPI 1265800940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265800940 NPI number — CLINIC AT SAMSONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINIC AT SAMSONS
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:
1265800940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17514 ENDEL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77407-2762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-459-9892
Provider Business Mailing Address Fax Number:
281-946-8466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3129 KINGSLEY DRIVE
Provider Second Line Business Practice Location Address:
UNIT 610
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-850-7162
Provider Business Practice Location Address Fax Number:
281-946-8466
Provider Enumeration Date:
09/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
NDUKWE
Authorized Official First Name:
STELLA
Authorized Official Middle Name:
ADA-IHUOMA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
832-850-7162

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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