1740029511 NPI number — MS. OLAMIDE OLUWADAMILDLA AJAYI MD

Table of content: MS. OLAMIDE OLUWADAMILDLA AJAYI MD (NPI 1740029511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740029511 NPI number — MS. OLAMIDE OLUWADAMILDLA AJAYI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AJAYI
Provider First Name:
OLAMIDE
Provider Middle Name:
OLUWADAMILDLA
Provider Name Prefix Text:
MS.
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:
1740029511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 COULTER STREET
Provider Second Line Business Mailing Address:
SUITE 1201
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-414-9786
Provider Business Mailing Address Fax Number:
806-354-5536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 COULTER STREET
Provider Second Line Business Practice Location Address:
SUITE 1201
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-414-9786
Provider Business Practice Location Address Fax Number:
806-354-5536
Provider Enumeration Date:
05/22/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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