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PROVIDENCE WELLNESS INC NPI 1790061315


NPI Information

NPI: 1790061315
Provider Name: PROVIDENCE WELLNESS INC

Doing Business As: PROVIDENCE MEDICAL

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 45D2026515

Address:
13155 WESTHEIMER ROAD
SUITE #133
HOUSTON, TX
ZIP 77077
Phone: (281) 920-0344
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PROVIDENCE WELLNESS INC is a clinic center in Houston, TX. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). PROVIDENCE WELLNESS INC NPI is 1790061315. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Medical.

The provider's business location address is:

13155 WESTHEIMER ROAD
SUITE #133
HOUSTON, TX
ZIP 77077
Phone: (281) 920-0344
Fax: (281) 920-0263

The provider's authorized official is Esther Akunna Eke-huber .
The authorized official title is Nurse Practitioner and has the following contact phone number (281) 920-0344.

The CLIA number assigned to this NPI record is 45D2026515 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/27/2011 and was last updated on 2/27/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LA2200XNurse PractitionerAdult HealthTEXASNo
2261Q00000XClinic/Center801287323TEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1TXB149978MEDICARE UPINTEXAS
2TXB149977MEDICARE PINTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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