Provider Demographics
NPI:1235807124
Name:ST BENEDICTA HEALTHCARE LLC
Entity Type:Organization
Organization Name:ST BENEDICTA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-344-3715
Mailing Address - Street 1:1717 TURNING BASIN DR STE 350
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-4059
Mailing Address - Country:US
Mailing Address - Phone:832-344-3715
Mailing Address - Fax:832-831-8226
Practice Address - Street 1:1717 TURNING BASIN DR STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-4059
Practice Address - Country:US
Practice Address - Phone:832-344-3715
Practice Address - Fax:832-831-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty