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General NPI Number Information
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NPI Number | 1114297116
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Entity Type | Organization
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Legal Business Name | CELINA MEMORIAL CLINIC INC
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 6746 WINDY RIVER LN
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City | KATY
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State | TX
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Zip | 77449-6344
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Country | US
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Telephone | 281-717-4805
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Fax | 832-262-4640
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Provider Business Mailing Address
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Address Line | 6746 WINDY RIVER LN
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City | KATY
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State | TX
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Zip | 77449-6344
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Country | US
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Telephone | 281-717-4805
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Fax | 832-262-4640
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Authorized Official
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Title or Position | CEO
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Name | DR. EBERE LOVELINE OBIDIKE
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Credential | MD
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Telephone | 832-757-0104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 801530292
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License Number State | TX
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