Basic Information
| Provider Information | |||||||||
| NPI: | 1396009668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EZIRIM | ||||||||
| FirstName: | NKECHI | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 WALLACE BLVD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791061708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064149650 | ||||||||
| FaxNumber: | 8063545730 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 S COULTER ST | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791061786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064149650 | ||||||||
| FaxNumber: | 8063545730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2012 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101255661 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 125058651 | IL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | Q9345 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200752300A | 05 | OK | MEDICAID | 380846102 | 05 | TX | MEDICAID | 380846101 | 05 | TX | MEDICAID | 73888770 | 05 | NM | MEDICAID |