=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588129167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINIC FOR LESS HOME VISIT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2019
-----------------------------------------------------
Last Update Date | 02/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 E LAMAR BLVD STE 600
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76006-7361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-946-3318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 E LAMAR BLVD STE 600
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76006-7361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-946-3318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | OSAZE KEN OSEMWENGIE
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 817-946-3318
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------