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General NPI Number Information
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NPI Number | 1790880391
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Entity Type | Organization
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Legal Business Name | ADVANCED HEALTH SYSTEMS OF AMERICA, PC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 3805 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-6334
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Country | US
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Telephone | 580-581-1994
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Fax | 580-581-1285
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Provider Business Mailing Address
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Address Line | 3805 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-6334
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Country | US
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Telephone | 580-581-1994
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Fax | 580-581-1285
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HENRY-NORBERT O. NDEKWE
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Credential | MD
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Telephone | 580-581-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21147 OK
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License Number State | OK
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