MEDICARE: MEGA MEDICAL CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	569795	TX

General Provider Information

NPI Number	:	1003837154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEGA MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	3124 HOLLY HALL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-4135
Country	:	US
Telephone Number	:	713-747-4492
Fax Number	:	713-747-4274

Provider Business Practice Location Address
First Line	:	3124 HOLLY HALL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-4135
Country	:	US
Telephone Number	:	713-747-4492
Fax Number	:	713-747-4274

Authorized Official
Title or Position	:	FNP-C
Name	:	MISS JUSTINA MEGWA
Credential	:	NP
Telephone Number	:	713-747-4492

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	10/29/2007

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