Provider Demographics
NPI:1588116990
Name:DIVTER G INC
Entity type:Organization
Organization Name:DIVTER G INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBI-OFODILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-347-4693
Mailing Address - Street 1:11901 SHADOW CREEK PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7346
Mailing Address - Country:US
Mailing Address - Phone:281-760-1971
Mailing Address - Fax:888-257-3780
Practice Address - Street 1:11901 SHADOW CREEK PKWY STE 111
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7346
Practice Address - Country:US
Practice Address - Phone:281-760-1971
Practice Address - Fax:888-257-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BN1400X
TXP7524261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies