1891193991 NPI number — THECLAR CHIKA OMEH NP

Table of content: THECLAR CHIKA OMEH NP (NPI 1891193991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891193991 NPI number — THECLAR CHIKA OMEH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OMEH
Provider First Name:
THECLAR
Provider Middle Name:
CHIKA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ONYEBUCHI
Provider Other First Name:
THECLAR
Provider Other Middle Name:
CHIKA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891193991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2130 CANYON CREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-8959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-498-3006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6431 FANNIN ST
Provider Second Line Business Practice Location Address:
MSB-5. 111
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-500-6295
Provider Business Practice Location Address Fax Number:
713-500-0706
Provider Enumeration Date:
12/05/2014

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: 363LF0000X , with the licence number:  F07141256 , 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)