Provider Demographics
NPI:1588796296
Name:N. W. HOUSTON FAMILY PRACTICE, P. A.
Entity Type:Organization
Organization Name:N. W. HOUSTON FAMILY PRACTICE, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:IBIWARI
Authorized Official - Last Name:AYOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-912-6282
Mailing Address - Street 1:PO BOX 692312
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-2312
Mailing Address - Country:US
Mailing Address - Phone:832-912-6282
Mailing Address - Fax:281-807-0457
Practice Address - Street 1:11706 FALLBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3510
Practice Address - Country:US
Practice Address - Phone:832-912-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00410TMedicare PIN