Provider Demographics
NPI:1134437189
Name:SHALOM MOBILE HEALTH MINISTRY
Entity type:Organization
Organization Name:SHALOM MOBILE HEALTH MINISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-900-2750
Mailing Address - Street 1:8121 BROADWAY ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-1340
Mailing Address - Country:US
Mailing Address - Phone:713-900-2750
Mailing Address - Fax:713-900-2751
Practice Address - Street 1:8121 BROADWAY ST
Practice Address - Street 2:STE. 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-1340
Practice Address - Country:US
Practice Address - Phone:713-900-2750
Practice Address - Fax:713-900-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01477363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty