Healthcare Provider Details

I. General information

NPI: 1679649669
Provider Name (Legal Business Name): CHILDRENS HEALTH OF OCALA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SE 25TH LOOP
OCALA FL
34471-6090
US

IV. Provider business mailing address

1301 SE 25TH LOOP
OCALA FL
34471-6090
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-1800
  • Fax:
Mailing address:
  • Phone: 352-671-1800
  • Fax: 352-671-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0073981
License Number StateFL

VIII. Authorized Official

Name: DR. CHRIS N OKONKWO
Title or Position: PRESIDENT
Credential: M.D
Phone: 352-671-1800