Healthcare Provider Details

I. General information

NPI: 1659812527
Provider Name (Legal Business Name): OBYKE HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3028 GENTILLY BLVD
NEW ORLEANS LA
70122-3808
US

IV. Provider business mailing address

3028 GENTILLY BLVD
NEW ORLEANS LA
70122-3808
US

V. Phone/Fax

Practice location:
  • Phone: 504-948-6080
  • Fax: 504-948-6089
Mailing address:
  • Phone: 504-948-6080
  • Fax: 504-948-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number6961
License Number StateLA

VIII. Authorized Official

Name: ROSE OKPALOBI
Title or Position: CEO
Credential:
Phone: 504-948-6080