Provider Demographics
NPI:1497004576
Name:MICAH HEALTHCARE INCOPORATED
Entity Type:Organization
Organization Name:MICAH HEALTHCARE INCOPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OBIONWU
Authorized Official - Suffix:
Authorized Official - Credentials:RN,CNM
Authorized Official - Phone:281-809-8019
Mailing Address - Street 1:14406 MANORBIER LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-9768
Mailing Address - Country:US
Mailing Address - Phone:845-323-9201
Mailing Address - Fax:281-933-5557
Practice Address - Street 1:2727 SYNOTT ROAD
Practice Address - Street 2:806
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:281-809-8019
Practice Address - Fax:281-809-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119623367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty