MEDICARE: IMANI HEALTH ASSOCIATES

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	261Q00000X	Clinic/Center	J2165	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720270630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMANI HEALTH ASSOCIATES

Provider Business Mailing Address
First Line	:	6118 IRISH HILL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3428
Country	:	US
Telephone Number	:	832-887-8992
Fax Number	:	713-669-1091

Provider Business Practice Location Address
First Line	:	6118 IRISH HILL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3428
Country	:	US
Telephone Number	:	832-887-8992
Fax Number	:	713-669-1091

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TONNETT OUTLAND
Credential	:
Telephone Number	:	832-725-1268

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	09/01/2009

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Directions to “IMANI HEALTH ASSOCIATES ” Practice Location

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