Provider Demographics
NPI:1801149869
Name:DR EDWARD CHIEKE NWANEGBO PA
Entity type:Organization
Organization Name:DR EDWARD CHIEKE NWANEGBO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CHIEKE
Authorized Official - Last Name:NWANEGBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-385-6424
Mailing Address - Street 1:1600 S SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-4810
Mailing Address - Country:US
Mailing Address - Phone:806-385-6424
Mailing Address - Fax:806-385-4305
Practice Address - Street 1:1600 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4810
Practice Address - Country:US
Practice Address - Phone:806-385-6424
Practice Address - Fax:806-385-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314194702Medicaid
TX0007YJOtherBCBS GROUP
TX314194701Medicaid
TX8DP363OtherBCBS INDIVIDUAL
268179YNKWMedicare PIN
TX0007YJOtherBCBS GROUP