Provider Demographics
NPI:1851639330
Name:OBI OKOLI LLC
Entity Type:Organization
Organization Name:OBI OKOLI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OBIEFUNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-522-6900
Mailing Address - Street 1:2801 E. MISSOURI AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5061
Mailing Address - Country:US
Mailing Address - Phone:575-522-6900
Mailing Address - Fax:575-522-8891
Practice Address - Street 1:2801 E. MISSOURI AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5061
Practice Address - Country:US
Practice Address - Phone:575-522-6900
Practice Address - Fax:575-522-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty