MEDICARE: CHINENYE OKECHUKWU MBACHU CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	AP128887	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01746196	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8394UL	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1083084081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHINENYE OKECHUKWU MBACHU CRNA

Provider Business Mailing Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:	210-916-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 ROGER BROOKE DR APT 300
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4517
Country	:	US
Telephone Number	:	210-916-4141
Fax Number	:	713-458-4229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2015
Last Update Date	:	06/22/2024

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Directions to “ CHINENYE OKECHUKWU MBACHU CRNA” Practice Location

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