MEDICARE: PAMELA OLABISI ADENUGA

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	332B00000X	Durable Medical Equipment & Medical Supplies	32015808465	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3-20158-0846-5	OTHER	TX	SALES AND USE TAX

General Provider Information

NPI Number	:	1639370356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA OLABISI ADENUGA

Provider Business Mailing Address
First Line	:	1901 SOUTHEAST PKWY
Second Line	:	SUITE 107
City	:	ARLINGTON
State	:	TX
Zip	:	76018-3605
Country	:	US
Telephone Number	:	817-557-1668
Fax Number	:	888-441-6930

Provider Business Practice Location Address
First Line	:	1901 SOUTHEAST PKWY
Second Line	:	SUITE 107
City	:	ARLINGTON
State	:	TX
Zip	:	76018-3605
Country	:	US
Telephone Number	:	817-557-1668
Fax Number	:	888-441-6930

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/27/2008

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Directions to “ PAMELA OLABISI ADENUGA ” Practice Location

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