MEDICARE: MR. ACHO JOHNSON OGBOENYIYA

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	332B00000X	Durable Medical Equipment & Medical Supplies	1000040	TX

General Provider Information

NPI Number	:	1962646174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ACHO JOHNSON OGBOENYIYA

Provider Business Mailing Address
First Line	:	10515 SOUTHWEST FWY
Second Line	:	SUIT D 103
City	:	HOUSTON
State	:	TX
Zip	:	77074-1127
Country	:	US
Telephone Number	:	713-777-1405
Fax Number	:	713-777-1420

Provider Business Practice Location Address
First Line	:	10515 SOUTHWEST FWY
Second Line	:	SUITE D 103
City	:	HOUSTON
State	:	TX
Zip	:	77074-1127
Country	:	US
Telephone Number	:	713-777-1405
Fax Number	:	713-777-1420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/01/2009

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