Provider Demographics
NPI:1356424121
Name:AWODOR G. OKO
Entity type:Organization
Organization Name:AWODOR G. OKO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AWODOR
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:OKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-974-3887
Mailing Address - Street 1:6201 BONHOMME RD STE 290-NN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4365
Mailing Address - Country:US
Mailing Address - Phone:713-974-3887
Mailing Address - Fax:713-974-3250
Practice Address - Street 1:6201 BONHOMME RD STE 290-NN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4365
Practice Address - Country:US
Practice Address - Phone:713-974-3887
Practice Address - Fax:713-974-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0077879332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1762221Medicaid
TX0000532004OtherPROVIDER NUMBER (BCBSTX)
TX0000532004OtherPROVIDER NUMBER (BCBSTX)