Provider Demographics
NPI:1508377599
Name:PROCENTURE LLC
Entity Type:Organization
Organization Name:PROCENTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IKE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ILOCHONWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-459-2566
Mailing Address - Street 1:5925 ALMEDA RD UNIT 11701
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7677
Mailing Address - Country:US
Mailing Address - Phone:713-459-2566
Mailing Address - Fax:
Practice Address - Street 1:2311 CANAL ST STE 214
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1566
Practice Address - Country:US
Practice Address - Phone:713-459-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty