MEDICARE: RELIABLE FAMILY & GERIATRICS PRACTICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	363LF0000X	Family Nurse Practitioner
3	363LG0600X	Gerontology Nurse Practitioner
4	363LP2300X	Primary Care Nurse Practitioner
5	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1477198869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE FAMILY & GERIATRICS PRACTICE

Provider Business Mailing Address
First Line	:	5530 W RIDGECREEK DR STE 250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3536
Country	:	US
Telephone Number	:	346-223-2195
Fax Number	:	346-998-1550

Provider Business Practice Location Address
First Line	:	5530 W RIDGECREEK DR STE 250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3536
Country	:	US
Telephone Number	:	346-277-2133
Fax Number	:	346-998-1550

Authorized Official
Title or Position	:	OWNER
Name	:	NDUBUISI DAVID ODIMEGWU
Credential	:	NP
Telephone Number	:	346-223-2195

Provider Enumeration Date	:	11/09/2019
Last Update Date	:	01/14/2022

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