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General NPI Number Information
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NPI Number | 1295166791
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Entity Type | Organization
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Legal Business Name | DR. A FAMILY CLINIC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 920 MEDICAL PLAZA DR SUITE 370
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City | SHENANDOAH
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State | TX
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Zip | 77380-3260
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Country | US
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Telephone | 763-670-5849
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Fax |
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Provider Business Mailing Address
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Address Line | 43 GINGER JAR ST
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City | THE WOODLANDS
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State | TX
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Zip | 77382-2806
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Country | US
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Telephone | 763-670-5849
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHINASA PAUL ANUGWOM
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Credential | MD
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Telephone | 763-670-5849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | P6574
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License Number State | TX
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