MEDICARE: JOBEL PRIMECARE CLINIC

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	261Q00000X	Clinic/Center
2	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1174106371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOBEL PRIMECARE CLINIC

Provider Business Mailing Address
First Line	:	2406 PALM HARBOUR DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6994
Country	:	US
Telephone Number	:	832-331-6255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 PALM HARBOUR DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6994
Country	:	US
Telephone Number	:	832-331-6255
Fax Number	:	412-202-4401

Authorized Official
Title or Position	:	PROVIDER
Name	:	DR. TONY ONONYE
Credential	:	DNP
Telephone Number	:	832-331-6255

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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