Provider Demographics
NPI:1477226082
Name:FIRST STEP TREATMENT CENTER INC
Entity Type:Organization
Organization Name:FIRST STEP TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUKOLA
Authorized Official - Middle Name:T
Authorized Official - Last Name:AMUDIPE
Authorized Official - Suffix:VIII
Authorized Official - Credentials:MD
Authorized Official - Phone:817-440-4247
Mailing Address - Street 1:6324 BRENTWOOD STAIR RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-3136
Mailing Address - Country:US
Mailing Address - Phone:817-440-4247
Mailing Address - Fax:
Practice Address - Street 1:6324 BRENTWOOD STAIR RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-3136
Practice Address - Country:US
Practice Address - Phone:817-440-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty