MEDICARE: NJNM CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center
2	261QR0200X	Radiology Clinic/Center		TX

General Provider Information

NPI Number	:	1073913943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NJNM CARE

Provider Business Mailing Address
First Line	:	P.O. BOX 4356
Second Line	:	DEPT. 609
City	:	HOUSTON
State	:	TX
Zip	:	77210-4356
Country	:	US
Telephone Number	:	281-292-7411
Fax Number	:	281-292-7481

Provider Business Practice Location Address
First Line	:	19073 I-45 SOUTH
Second Line	:	SUITE 145
City	:	SHENANDOAH
State	:	TX
Zip	:	77385-8744
Country	:	US
Telephone Number	:	281-292-7411
Fax Number	:	281-292-7481

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. KENT OLSAN
Credential	:
Telephone Number	:	281-292-7411

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/11/2015

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Directions to “NJNM CARE ” Practice Location

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