Healthcare Provider Details

I. General information

NPI: 1265568042
Provider Name (Legal Business Name): CALVARY MEDICAL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SOUTH WILLIAM BARNETT AVE
CLEVELAND TX
77327
US

IV. Provider business mailing address

108 S WILLIAM BARNETT AVE
CLEVELAND TX
77327-4542
US

V. Phone/Fax

Practice location:
  • Phone: 281-659-2355
  • Fax: 281-592-1570
Mailing address:
  • Phone: 281-659-2355
  • Fax: 281-592-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberK5963
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NIMIMIAYIFA B KEATING
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 281-659-2355