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General NPI Number Information
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NPI Number | 1073779054
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Entity Type | Organization
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Legal Business Name | SAHASRA MEDICAL CLINIC
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 4141 SOUTHWEST FWY STE 510
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City | HOUSTON
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State | TX
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Zip | 77027-7334
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Country | US
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Telephone | 832-699-9734
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Fax | 281-710-6222
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Provider Business Mailing Address
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Address Line | 1403 BODENGER BLVD
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City | NEW ORLEANS
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State | LA
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Zip | 70114-6001
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Country | US
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Telephone | 832-699-9734
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Fax | 281-710-6222
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Authorized Official
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Title or Position | OWNER
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Name | IESHA ISHEA GRANT
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Credential | APRN-BC
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Telephone | 504-762-0245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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