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General NPI Number Information
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NPI Number | 1639189954
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Entity Type | Organization
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Legal Business Name | CHISOM MEDICAL GROUP LLC.
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10511 JONES RD E
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City | HOUSTON
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State | TX
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Zip | 77065-4291
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Country | US
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Telephone | 281-469-2300
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Fax | 281-469-2315
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Provider Business Mailing Address
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Address Line | 10511 JONES RD E
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City | HOUSTON
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State | TX
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Zip | 77065-4291
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Country | US
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Telephone | 281-469-2300
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Fax | 281-469-2315
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SYLVESTER CHUKWUEMEKA OGUH
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Credential |
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Telephone | 601-454-3878
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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 | 0089455
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License Number State | TX
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