MEDICARE: ANIOMA INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1659621332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANIOMA INC.

Provider Business Mailing Address
First Line	:	4030 PONCHATRAIN DR.
Second Line	:	MAILBOX 305
City	:	SLIDELL
State	:	NEW ORLEANS
Zip	:	70458
Country	:	UM
Telephone Number	:	504-240-3056
Fax Number	:

Provider Business Practice Location Address
First Line	:	10001 LAKE FOREST BLVD
Second Line	:	SUITE 616
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-6200
Country	:	US
Telephone Number	:	504-240-3056
Fax Number	:	504-324-0409

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IFEANYI OKPALOBI JR.
Credential	:
Telephone Number	:	504-240-3056

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	04/07/2015

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Directions to “ANIOMA INC. ” Practice Location

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