MEDICARE: JUSTINA N EKWOROMADU

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	0108079	TX

General Provider Information

NPI Number	:	1689810442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSTINA N EKWOROMADU

Provider Business Mailing Address
First Line	:	9696 SKILLMAN ST
Second Line	:	SUITE 265
City	:	DALLAS
State	:	TX
Zip	:	75243-8264
Country	:	US
Telephone Number	:	214-503-7415
Fax Number	:	214-503-7451

Provider Business Practice Location Address
First Line	:	9696 SKILLMAN ST
Second Line	:	SUITE 265
City	:	DALLAS
State	:	TX
Zip	:	75243-8264
Country	:	US
Telephone Number	:	214-503-7415
Fax Number	:	214-503-7451

Authorized Official
Title or Position	:	MANAGER/ADMINISTRATOR
Name	:	MRS. JUSTINA E EKWOROMADU
Credential	:
Telephone Number	:	214-503-7415

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	05/27/2011

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