1780642488 NPI number — DR. IFEOMA N ARENE MD

Table of content: DR. IFEOMA N ARENE MD (NPI 1780642488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780642488 NPI number — DR. IFEOMA N ARENE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARENE
Provider First Name:
IFEOMA
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
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:
1780642488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12828 WILLOW CTR
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77066-3043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-893-3656
Provider Business Mailing Address Fax Number:
281-893-3464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12828 WILLOW CTR
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77066-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-893-3656
Provider Business Practice Location Address Fax Number:
281-893-3464
Provider Enumeration Date:
05/02/2006

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: 2084P0800X , with the licence number:  L5229 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: L5229 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 157916104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 312658605 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 01161084 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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