MEDICARE: NOVA FAMILY HEALTH AND WELLNESS CLINIC LLC

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1154919892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA FAMILY HEALTH AND WELLNESS CLINIC LLC

Provider Business Mailing Address
First Line	:	29127 GARDEN RIVER CT
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-1778
Country	:	US
Telephone Number	:	161-459-9390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S DAIRY ASHFORD RD STE 100-171
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2375
Country	:	US
Telephone Number	:	614-599-3900
Fax Number	:	281-346-8625

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDITH EMENIKE - OGBORU
Credential	:	FNP
Telephone Number	:	614-599-3900

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	09/05/2021

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