1497004576 NPI number — MICAH HEALTHCARE INCOPORATED

Table of content: (NPI 1497004576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497004576 NPI number — MICAH HEALTHCARE INCOPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICAH HEALTHCARE INCOPORATED
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:
1497004576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14406 MANORBIER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77498-9768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-323-9201
Provider Business Mailing Address Fax Number:
281-933-5557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 SYNOTT ROAD
Provider Second Line Business Practice Location Address:
806
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-809-8019
Provider Business Practice Location Address Fax Number:
281-809-8019
Provider Enumeration Date:
09/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OBIONWU
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SUPERVISING NURSE
Authorized Official Telephone Number:
281-809-8019

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  AP119623 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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