=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043543846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | U&I HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2009
-----------------------------------------------------
Last Update Date | 09/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10225 BISSONNET ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-7800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-880-2788
-----------------------------------------------------
Fax | 713-988-0886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 710227
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77271-0227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-880-2788
-----------------------------------------------------
Fax | 713-988-0886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. OSITA ANTHONY OKONTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-880-2788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251X00000X
-----------------------------------------------------
Taxonomy Name | Supports Brokerage Agency
-----------------------------------------------------
License Number | 10273337
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------