Provider Demographics
NPI:1710160304
Name:OBIAKO MEDICAL SUPPLY
Entity Type:Organization
Organization Name:OBIAKO MEDICAL SUPPLY
Other - Org Name:OBIAKO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ONYE
Authorized Official - Middle Name:A
Authorized Official - Last Name:UDOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-432-5784
Mailing Address - Street 1:10504 COLFAX DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2974
Mailing Address - Country:US
Mailing Address - Phone:214-432-5784
Mailing Address - Fax:
Practice Address - Street 1:10504 COLFAX DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2974
Practice Address - Country:US
Practice Address - Phone:214-432-5784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OBIAKO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-06
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0099246332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies