Provider Demographics
NPI:1174106371
Name:JOBEL PRIMECARE CLINIC
Entity type:Organization
Organization Name:JOBEL PRIMECARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONONYE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:832-331-6255
Mailing Address - Street 1:2406 PALM HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6994
Mailing Address - Country:US
Mailing Address - Phone:832-331-6255
Mailing Address - Fax:
Practice Address - Street 1:2406 PALM HARBOUR DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6994
Practice Address - Country:US
Practice Address - Phone:832-331-6255
Practice Address - Fax:412-202-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center