Provider Demographics
NPI:1578551222
Name:BERNARD OKONKWO
Entity Type:Organization
Organization Name:BERNARD OKONKWO
Other - Org Name:EXCELLENT MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:AMAECHI
Authorized Official - Last Name:OKONKWO
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, MSIS
Authorized Official - Phone:713-440-9800
Mailing Address - Street 1:2807 OLD SPANISH TRL
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2207
Mailing Address - Country:US
Mailing Address - Phone:281-932-2255
Mailing Address - Fax:713-440-9803
Practice Address - Street 1:2807 OLD SPANISH TRAIL
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-440-9800
Practice Address - Fax:713-440-9803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X332B00000X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144446502Medicaid
TX4172100001Medicare ID - Type UnspecifiedPROVIDER NUMBER