Provider Demographics
NPI:1487670857
Name:VINCENT C. IGBOKWE
Entity Type:Organization
Organization Name:VINCENT C. IGBOKWE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:CHIWEUBA
Authorized Official - Last Name:IGBOKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-956-8195
Mailing Address - Street 1:300 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3940
Mailing Address - Country:US
Mailing Address - Phone:972-956-8195
Mailing Address - Fax:972-956-8198
Practice Address - Street 1:300 N MILL ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3940
Practice Address - Country:US
Practice Address - Phone:972-956-8195
Practice Address - Fax:972-956-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0082703332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5497860001Medicare ID - Type Unspecified