Provider Demographics
NPI:1689185845
Name:OKORO, FIDELIS U (CEO/OWNER)
Entity Type:Individual
Prefix:MR
First Name:FIDELIS
Middle Name:U
Last Name:OKORO
Suffix:
Gender:M
Credentials:CEO/OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 ELLINGSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4550
Mailing Address - Country:US
Mailing Address - Phone:504-914-1248
Mailing Address - Fax:986-605-7207
Practice Address - Street 1:7240 CROWDER BLVD STE 300I
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1923
Practice Address - Country:US
Practice Address - Phone:504-914-1248
Practice Address - Fax:985-605-7207
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA827500343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA822675605Medicaid
LA007848835Medicaid