| Kingsley C Okonkwo, MD | |
|
912 E 5th St, Odessa, TX 79761-4605 | |
| (432) 334-8845 | |
| (432) 334-8875 |
| Full Name | Kingsley C Okonkwo |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 912 E 5th St, Odessa, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982732178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2080P0202X | Pediatrics - Pediatric Cardiology | 4301093606 (Michigan) | Secondary |
| 208000000X | Pediatrics | P4362 (Texas) | Primary |
| Entity Name | Roswell Clinic Corp |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649267618 PECOS PAC ID: 9436062759 Enrollment ID: O20031111000799 |
| Entity Name | St Vincent Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1578587150 PECOS PAC ID: 6608775135 Enrollment ID: O20040105000372 |
| Mailing Address | Practice Location Address |
|---|---|
| Kingsley C Okonkwo, MD 912 E 5th St, Odessa, TX 79761-4605 Ph: (432) 334-8845 | Kingsley C Okonkwo, MD 912 E 5th St, Odessa, TX 79761-4605 Ph: (432) 334-8845 |
Dr. Carlos Nieto Jr., M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 701 W 5th St, Odessa, TX 79763 Phone: 432-335-1500 Fax: 432-335-1537 | |
Dr. Stephanie Villarreal, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 701 W 5th St, Odessa, TX 79763 Phone: 432-335-2222 | |
Olajide A Sowemimo, Pediatrics Medicare: Not Enrolled in Medicare Practice Location: Texas Tech University Health Sciences Complex, 701 West 5th Street, Odessa, TX 79763 Phone: 432-703-6310 | |
Manisha Mahadev Desai, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 29 Dolores Ct, Odessa, TX 79765 Phone: 432-561-8797 | |
Randa N. A Othman, M.D Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 701 W 5th St, Odessa, TX 79763 Phone: 432-335-1421 Fax: 432-335-1807 | |
Dr. Venkataramana P. Garikiparthy, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 701 W 5th St, Odessa, TX 79763 Phone: 432-703-5150 | |
Manjula Mudduluru, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 701 W 5th St, Odessa, TX 79763 Phone: 432-703-5310 Fax: 432-335-5354 |