1073842324 NPI number — ISRAEL OJIMADU CEO

Table of content: ISRAEL OJIMADU CEO (NPI 1073842324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073842324 NPI number — ISRAEL OJIMADU CEO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OJIMADU
Provider First Name:
ISRAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CEO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073842324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7048 KNIGHTDALE BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
KNIGHTDALE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27545-8894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-266-3591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 SAYORNIS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27615-8114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-247-8391
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2009

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: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3409683 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".