Provider Demographics
NPI:1700279742
Name:LA PROVIDENCE MEDICAL CENTER
Entity Type:Organization
Organization Name:LA PROVIDENCE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IFEYINWA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUDIWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-206-0766
Mailing Address - Street 1:8511 N HOUSTON ROSSLYN RD STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-6433
Mailing Address - Country:US
Mailing Address - Phone:713-981-6002
Mailing Address - Fax:
Practice Address - Street 1:8511 N HOUSTON ROSSLYN RD STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-6433
Practice Address - Country:US
Practice Address - Phone:713-981-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty