Healthcare Provider Details

I. General information

NPI: 1689909681
Provider Name (Legal Business Name): PATRICK E OGBEIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 WESTSHORE DR
ROWLETT TX
75088-5695
US

IV. Provider business mailing address

3002 WESTSHORE DR
ROWLETT TX
75088-5695
US

V. Phone/Fax

Practice location:
  • Phone: 214-725-5080
  • Fax: 469-366-7699
Mailing address:
  • Phone: 214-725-5080
  • Fax: 469-366-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010833
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: