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General NPI Number Information
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NPI Number | 1184813727
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Entity Type | Organization
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Legal Business Name | THE IMUNIZATION CLINIC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 440 BENMAR DR SUITE 3020
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City | HOUSTON
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State | TX
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Zip | 77060-3165
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Country | US
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Telephone | 281-260-6600
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Fax | 281-260-6603
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Provider Business Mailing Address
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Address Line | 440 BENMAR DR SUITE 3020
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City | HOUSTON
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State | TX
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Zip | 77060-3165
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Country | US
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Telephone | 281-260-6600
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Fax | 281-260-6603
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. KAREN A. SMILEY
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Credential | R.N.
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Telephone | 281-260-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 559388
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License Number State | TX
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