Provider Demographics
NPI:1912231747
Name:EVANGELINE MEMORIAL CLINIC, INC
Entity Type:Organization
Organization Name:EVANGELINE MEMORIAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:NKECHI
Authorized Official - Last Name:OJIH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, ANP-BC
Authorized Official - Phone:281-888-3671
Mailing Address - Street 1:10039 BISSONNET ST
Mailing Address - Street 2:307
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7854
Mailing Address - Country:US
Mailing Address - Phone:281-888-3671
Mailing Address - Fax:
Practice Address - Street 1:10039 BISSONNET ST
Practice Address - Street 2:307
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7854
Practice Address - Country:US
Practice Address - Phone:281-888-3671
Practice Address - Fax:281-888-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-26
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601731363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty