Provider Demographics
NPI:1568646636
Name:CHINWE NDUKA MD FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:CHINWE NDUKA MD FAMILY PRACTICE PA
Other - Org Name:ECKLAND MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINWE
Authorized Official - Middle Name:
Authorized Official - Last Name:NDUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-774-0458
Mailing Address - Street 1:125 W HAGUE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5811
Mailing Address - Country:US
Mailing Address - Phone:915-774-0458
Mailing Address - Fax:915-774-0027
Practice Address - Street 1:3515 GATEWAY BLVD W
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4413
Practice Address - Country:US
Practice Address - Phone:915-774-0458
Practice Address - Fax:915-774-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00964RMedicare PIN