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General NPI Number Information
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NPI Number | 1134437189
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Entity Type | Organization
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Legal Business Name | SHALOM MOBILE HEALTH MINISTRY
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 8121 BROADWAY ST STE. 103
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City | HOUSTON
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State | TX
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Zip | 77061-1340
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Country | US
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Telephone | 713-900-2750
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Fax | 713-900-2751
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Provider Business Mailing Address
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Address Line | 8121 BROADWAY ST STE. 103
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City | HOUSTON
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State | TX
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Zip | 77061-1340
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Country | US
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Telephone | 713-900-2750
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Fax | 713-900-2751
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MONICA KING
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Credential |
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Telephone | 713-900-2750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA01477
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License Number State | TX
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