1114214061 NPI number — DR. ADAEZE CHIMEOGO NWOSU M.D.

Table of content: DR. ADAEZE CHIMEOGO NWOSU M.D. (NPI 1114214061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114214061 NPI number — DR. ADAEZE CHIMEOGO NWOSU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NWOSU
Provider First Name:
ADAEZE
Provider Middle Name:
CHIMEOGO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OKAFOR
Provider Other First Name:
ADAEZE
Provider Other Middle Name:
CHIMEOGO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114214061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 S SEGUIN AVE STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78130-3915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-468-5600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1054 TEXAN TRL
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GRAPEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76051-3784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-682-1710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  Q2357 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)