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General NPI Number Information
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NPI Number | 1619268810
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Entity Type | Organization
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Legal Business Name | PATRICK E IGBOKWE
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 4798 HIGHWAY 61 S SUITE B
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City | VICKSBURG
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State | MS
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Zip | 39180-7125
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Country | US
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Telephone | 601-630-9300
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Fax | 601-630-0133
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Provider Business Mailing Address
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Address Line | 209 KENDRA DR
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City | VICKSBURG
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State | MS
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Zip | 39180-8986
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Country | US
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Telephone | 601-630-9300
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Fax | 601-630-0133
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | PATRICK E IGBOKWE
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Credential |
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Telephone | 601-636-3692
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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 | 07659/11.1
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License Number State | MS
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