=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285869529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIBICARE FAMILY HEALTH CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2009
-----------------------------------------------------
Last Update Date | 06/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12660 BEECHNUT ST 110
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77072-3981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-564-2242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12660 BEECHNUT 110
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-564-2242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. BERNADETTE UCHE IGUH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 281-564-2242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------