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General NPI Number Information
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NPI Number | 1952532129
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Entity Type | Organization
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Legal Business Name | ST. JOHNS FAMILY MEDICINE CLINIC
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 8130 LONG POINT RD
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City | HOUSTON
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State | TX
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Zip | 77055-2006
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Country | US
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Telephone | 713-464-3600
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Fax | 713-464-3602
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Provider Business Mailing Address
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Address Line | 8130 LONG POINT RD
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City | HOUSTON
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State | TX
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Zip | 77055-2006
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Country | US
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Telephone | 713-464-3600
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Fax | 713-464-3602
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Authorized Official
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Title or Position | OWNER
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Name | PROF. JOHN O NGENE
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Credential | FNP
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Telephone | 832-492-3922
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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 | 610855
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License Number State | TX
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