MEDICARE: BERNARD OKONKWO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies	332B00000X	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578551222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNARD OKONKWO

Provider Business Mailing Address
First Line	:	2807 OLD SPANISH TRL
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77054-2207
Country	:	US
Telephone Number	:	281-932-2255
Fax Number	:	713-440-9803

Provider Business Practice Location Address
First Line	:	2807 OLD SPANISH TRAIL
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77054
Country	:	US
Telephone Number	:	713-440-9800
Fax Number	:	713-440-9803

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. BERNARD AMAECHI OKONKWO
Credential	:	BSC, MSIS
Telephone Number	:	713-440-9800

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	06/26/2023

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Directions to “BERNARD OKONKWO ” Practice Location

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