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General NPI Number Information
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NPI Number | 1184881013
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Entity Type | Organization
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Legal Business Name | SHELDON EXTRACARE FAMILY PRACTICE
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 8514 C E KING PKWY SUITE T
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City | HOUSTON
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State | TX
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Zip | 77044-2344
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Country | US
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Telephone | 281-458-4707
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Fax | 281-458-4700
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Provider Business Mailing Address
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Address Line | 8514 C E KING PKWY SUITE T
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City | HOUSTON
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State | TX
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Zip | 77044-2344
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Country | US
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Telephone | 281-458-4707
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Fax | 281-458-4700
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MS. LATINA BLAIR
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Credential | PA-C
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Telephone | 281-458-4707
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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 | K4259
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | PA03060
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License Number State | TX
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