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General NPI Number Information
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NPI Number | 1215444237
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Entity Type | Organization
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Legal Business Name | EMINENT PROVIDER SERVICES
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Dates
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Enumeration Date | 12/30/2017
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Last Update Date | 12/30/2017
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Provider Practice Location Address
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Address Line | 911 MARIGOLD PARK PL
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City | RICHMOND
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State | TX
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Zip | 77406-7867
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Country | US
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Telephone | 832-419-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 911 MARIGOLD PARK PL
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City | RICHMOND
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State | TX
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Zip | 77406-7867
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Country | US
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Telephone | 832-419-8886
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | EZIECHINA OKWOR
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Credential |
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Telephone | 832-419-8886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 782296
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License Number State | TX
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