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General NPI Number Information
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NPI Number | 1790248987
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Entity Type | Organization
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Legal Business Name | AVID HEALTHCARE SERVICES PA
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Dates
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Enumeration Date | 04/13/2019
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Last Update Date | 04/13/2019
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Provider Practice Location Address
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Address Line | 604 N ROCKWALL AVE
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City | TERRELL
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State | TX
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Zip | 75160-2117
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Country | US
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Telephone | 972-522-8524
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Fax |
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Provider Business Mailing Address
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Address Line | 18 KESTREL CT
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City | HEATH
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State | TX
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Zip | 75032-2043
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Country | US
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Telephone | 214-675-3859
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID OKUMBOR
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Credential | MD
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Telephone | 214-675-3859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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