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General NPI Number Information
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NPI Number | 1588116990
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Entity Type | Organization
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Legal Business Name | DIVTER G INC
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 11901 SHADOW CREEK PKWY STE 111
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City | PEARLAND
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State | TX
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Zip | 77584-7346
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Country | US
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Telephone | 281-760-1971
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Fax | 888-257-3780
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Provider Business Mailing Address
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Address Line | 11901 SHADOW CREEK PKWY STE 111
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City | PEARLAND
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State | TX
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Zip | 77584-7346
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Country | US
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Telephone | 281-760-1971
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Fax | 888-257-3780
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL OBI-OFODILE
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Credential | MD
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Telephone | 229-347-4693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | P7524
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License Number State | TX
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