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General NPI Number Information
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NPI Number | 1891558672
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Entity Type | Organization
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Legal Business Name | MEDEKAN ONLINE SERVICES
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 2743 SMITH RANCH RD STE 902A
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City | PEARLAND
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State | TX
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Zip | 77584-5217
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Country | US
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Telephone | 346-582-8336
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Fax | 713-583-7836
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Provider Business Mailing Address
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Address Line | 1853 PEARLAND PKWY STE 123-1145
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City | PEARLAND
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State | TX
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Zip | 77581-5296
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Country | US
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Telephone | 346-582-8336
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Fax | 713-583-7839
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Authorized Official
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Title or Position | OWNER
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Name | MIRIAM UDOKAH
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Credential |
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Telephone | 346-582-8336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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