Provider Demographics
NPI:1245720911
Name:GREATER MEDICAL MISSION GROUP PLLC
Entity type:Organization
Organization Name:GREATER MEDICAL MISSION GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:UGHWANMWAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:EFEOVBOKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:GNP-BC
Authorized Official - Phone:210-908-9358
Mailing Address - Street 1:11631 CAMP REAL LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6331
Mailing Address - Country:US
Mailing Address - Phone:210-908-9358
Mailing Address - Fax:210-239-5921
Practice Address - Street 1:426 CASTROVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207
Practice Address - Country:US
Practice Address - Phone:877-664-7201
Practice Address - Fax:800-218-7489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty