MEDICARE: APOLLO MEN'S HEALTH

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	261QP2300X	Primary Care Clinic/Center	AP126802	TX
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1104359710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOLLO MEN'S HEALTH

Provider Business Mailing Address
First Line	:	2404 SMITH RANCH RD STE 300
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5201
Country	:	US
Telephone Number	:	832-664-9966
Fax Number	:	832-664-9929

Provider Business Practice Location Address
First Line	:	190 ABNER JACKSON PKWY STE 110
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5171
Country	:	US
Telephone Number	:	979-316-3437
Fax Number	:	979-529-9947

Authorized Official
Title or Position	:	OWNER
Name	:	OROBOSA EMMANUEL OGHIDE
Credential	:
Telephone Number	:	979-316-3437

Provider Enumeration Date	:	04/10/2017
Last Update Date	:	04/06/2026

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