Organization Active NPI

Havilah Medical and Wellness LLC

  • Internal Medicine Physician
  • Katy, TX
National Provider Identifier
1043045768
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
HAVILAH MEDICAL AND WELLNESS LLC
Practice address
440 Cobia Dr Ste 701
Katy, TX 77494-6892
Phone
(317) 457-1668
NPI assigned
Sep 3, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Magdelene Amoateng, MDNPI 1801356100
Title
Owner
Phone
(317) 457-1668

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

440 Cobia Dr Ste 701
Katy, TX 77494-6892

Mailing address

24303 Oasis Bend Dr
Katy, TX 77493-3851

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250310002500 TX Part B Supplier - Clinic/Group Practice 0345761151 Receives reassigned benefits from 1 practitioner
Practice locations: Katy, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747008000000",
    "number": "1043045768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24303 OASIS BEND DR",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774933851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 COBIA DR STE 701",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774946892",
            "telephone_number": "317-457-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVILAH MEDICAL AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-03",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A",
        "authorized_official_last_name": "AMOATENG",
        "authorized_official_first_name": "MAGDELENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-457-1668",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Katy, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.