MEDICARE: EVANGEL HEALTHCARE CHARITIES, 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	332B00000X	Durable Medical Equipment & Medical Supplies		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	388115	OTHER	TX	COUNTY CLERK NUMBER

General Provider Information

NPI Number	:	1659353019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANGEL HEALTHCARE CHARITIES, INC

Provider Business Mailing Address
First Line	:	5138 JEFFERSON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3227
Country	:	US
Telephone Number	:	713-923-6620
Fax Number	:	713-921-0008

Provider Business Practice Location Address
First Line	:	5138 JEFFERSON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3227
Country	:	US
Telephone Number	:	713-923-6620
Fax Number	:	713-921-0008

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MEKA ODUNZE
Credential	:
Telephone Number	:	713-923-6620

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/22/2020

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