Provider Demographics
NPI:1952532129
Name:ST. JOHNS FAMILY MEDICINE CLINIC
Entity type:Organization
Organization Name:ST. JOHNS FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:NGENE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:832-492-3922
Mailing Address - Street 1:8130 LONG POINT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-2006
Mailing Address - Country:US
Mailing Address - Phone:713-464-3600
Mailing Address - Fax:713-464-3602
Practice Address - Street 1:8130 LONG POINT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-2006
Practice Address - Country:US
Practice Address - Phone:713-464-3600
Practice Address - Fax:713-464-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610855261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care