Healthcare Provider Details

I. General information

NPI: 1689185845
Provider Name (Legal Business Name): FIDELIS U OKORO CEO/OWNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7240 CROWDER BLVD STE 300I
NEW ORLEANS LA
70127-1923
US

IV. Provider business mailing address

1605 ELLINGSWORTH DR
SLIDELL LA
70461-4550
US

V. Phone/Fax

Practice location:
  • Phone: 504-914-1248
  • Fax: 985-605-7207
Mailing address:
  • Phone: 504-914-1248
  • Fax: 986-605-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberA827500
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: