Provider Demographics
NPI:1477198869
Name:RELIABLE FAMILY & GERIATRICS PRACTICE
Entity Type:Organization
Organization Name:RELIABLE FAMILY & GERIATRICS PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NDUBUISI
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ODIMEGWU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:346-223-2195
Mailing Address - Street 1:5530 W RIDGECREEK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-3536
Mailing Address - Country:US
Mailing Address - Phone:346-223-2195
Mailing Address - Fax:346-998-1550
Practice Address - Street 1:5530 W RIDGECREEK DR STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-3536
Practice Address - Country:US
Practice Address - Phone:346-277-2133
Practice Address - Fax:346-998-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-09
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty