Provider Demographics
NPI:1962863761
Name:SIR AKOMA MEMORIAL FOUNDATION CLINIC INC.
Entity Type:Organization
Organization Name:SIR AKOMA MEMORIAL FOUNDATION CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EBERE
Authorized Official - Middle Name:LOVELINE
Authorized Official - Last Name:UZOETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-614-0736
Mailing Address - Street 1:301 S 9TH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3448
Mailing Address - Country:US
Mailing Address - Phone:832-614-0736
Mailing Address - Fax:832-553-3036
Practice Address - Street 1:301 S 9TH ST STE 215
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3448
Practice Address - Country:US
Practice Address - Phone:832-614-0736
Practice Address - Fax:832-553-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty