Provider Demographics
NPI:1073691952
Name:OKORIE, PIUS O (CEO)
Entity Type:Individual
Prefix:MR
First Name:PIUS
Middle Name:O
Last Name:OKORIE
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 US HIGHWAY 80 E STE 168
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-8105
Mailing Address - Country:US
Mailing Address - Phone:972-613-8400
Mailing Address - Fax:972-613-8406
Practice Address - Street 1:3939 US HIGHWAY 80 E STE 168
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-8105
Practice Address - Country:US
Practice Address - Phone:972-613-8400
Practice Address - Fax:972-613-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0066402332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4871360001Medicare ID - Type UnspecifiedPROVIDER NUMBER