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General NPI Number Information
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NPI Number | 1073691952
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Entity Type | Individual
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Provider Name | PIUS O OKORIE CEO
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3939 US HIGHWAY 80 E STE 168
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City | MESQUITE
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State | TX
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Zip | 75150-8105
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Country | US
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Telephone | 972-613-8400
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Fax | 972-613-8406
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Provider Business Mailing Address
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Address Line | 3939 US HIGHWAY 80 E STE 168
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City | MESQUITE
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State | TX
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Zip | 75150-8105
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Country | US
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Telephone | 972-613-8400
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Fax | 972-613-8406
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0066402
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License Number State | TX
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