1144501875 NPI number — CHIOMA J MGBOKWERE MD

Table of content: CHIOMA J MGBOKWERE MD (NPI 1144501875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144501875 NPI number — CHIOMA J MGBOKWERE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MGBOKWERE
Provider First Name:
CHIOMA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1144501875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13800 EASTLAKE DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
HORIZON CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79928-7297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-577-1134
Provider Business Mailing Address Fax Number:
915-577-1136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13800 EASTLAKE DR
Provider Second Line Business Practice Location Address:
SUITE400
Provider Business Practice Location Address City Name:
HORIZON CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79928-7297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-577-1134
Provider Business Practice Location Address Fax Number:
915-577-1136
Provider Enumeration Date:
09/08/2011

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: 207P00000X , with the licence number:  P0856 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: P0856 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: P0856 , 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)

  • Identifier: 299693603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01279531 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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