=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770374209
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROMEDIX HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2025
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13916 LEXINGTON BLVD
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-5362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-715-7110
-----------------------------------------------------
Fax | 281-715-7227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13916 LEXINGTON BLVD
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-5362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE ADMINISTRATOR
-----------------------------------------------------
Name | DR. UCHE EGBUCHUNAM
-----------------------------------------------------
Credential | BSC, PHARMD
-----------------------------------------------------
Telephone | 281-715-7110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------