Healthcare Provider Details

I. General information

NPI: 1073691952
Provider Name (Legal Business Name): PIUS O OKORIE CEO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 US HIGHWAY 80 E STE 168
MESQUITE TX
75150-8105
US

IV. Provider business mailing address

3939 US HIGHWAY 80 E STE 168
MESQUITE TX
75150-8105
US

V. Phone/Fax

Practice location:
  • Phone: 972-613-8400
  • Fax: 972-613-8406
Mailing address:
  • Phone: 972-613-8400
  • Fax: 972-613-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0066402
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: