Provider Demographics
NPI:1447716105
Name:SHARED COMMUNITY HEALTH CLINIC
Entity type:Organization
Organization Name:SHARED COMMUNITY HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROQUEMORE-GORDY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:832-244-4621
Mailing Address - Street 1:9432 KATY FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6367
Mailing Address - Country:US
Mailing Address - Phone:832-244-4621
Mailing Address - Fax:
Practice Address - Street 1:9432 KATY FWY STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6367
Practice Address - Country:US
Practice Address - Phone:832-244-4621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty