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General NPI Number Information
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NPI Number | 1326569716
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Entity Type | Organization
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Legal Business Name | ST. JOHNS FAMILY MEDICINE CLINIC, LLC
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7640 AIRLINE DR UNIT D
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City | HOUSTON
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State | TX
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Zip | 77037-4621
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Country | US
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Telephone | 281-741-2157
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Fax | 281-741-9125
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Provider Business Mailing Address
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Address Line | 7640 AIRLINE DR UNIT D
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City | HOUSTON
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State | TX
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Zip | 77037-4621
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Country | US
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Telephone | 281-741-2157
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Fax | 281-741-9125
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN NGENE
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Credential |
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Telephone | 281-741-2157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AP116408
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License Number State | TX
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