1427229301 NPI number — CHRISTIANA N.AKOMA DBA CITIZENS HEALTH CENTER

Table of content: (NPI 1427229301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427229301 NPI number — CHRISTIANA N.AKOMA DBA CITIZENS HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIANA N.AKOMA DBA CITIZENS HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1427229301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4203 AVENUE H
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
ROSENBERG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77471-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-595-6552
Provider Business Mailing Address Fax Number:
832-595-6071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4203 AVENUE H
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
ROSENBERG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77471-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-595-6552
Provider Business Practice Location Address Fax Number:
832-595-6071
Provider Enumeration Date:
03/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AKOMA
Authorized Official First Name:
CHRISTIANA
Authorized Official Middle Name:
NWAOGBU
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-595-6552

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  430038 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 430038 , 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: 173537501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00303Y . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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