Provider Demographics
NPI:1003837154
Name:MEGA MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:MEGA MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:MISS
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGWA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-747-4492
Mailing Address - Street 1:3124 HOLLY HALL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4135
Mailing Address - Country:US
Mailing Address - Phone:713-747-4492
Mailing Address - Fax:713-747-4274
Practice Address - Street 1:3124 HOLLY HALL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4135
Practice Address - Country:US
Practice Address - Phone:713-747-4492
Practice Address - Fax:713-747-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W858Medicare PIN