Provider Demographics
NPI:1710406616
Name:CHRISTIAN PROVIDER SERVICES INC
Entity Type:Organization
Organization Name:CHRISTIAN PROVIDER SERVICES INC
Other - Org Name:CHRISTIAN MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OKENDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-891-8184
Mailing Address - Street 1:1501 E MOCKINGBIRD LN STE 234
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2189
Mailing Address - Country:US
Mailing Address - Phone:800-891-2184
Mailing Address - Fax:281-988-5391
Practice Address - Street 1:1501 E MOCKINGBIRD LN STE 234
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2189
Practice Address - Country:US
Practice Address - Phone:800-891-2184
Practice Address - Fax:281-988-5391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN PROVIDER SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001559332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment