Provider Demographics
NPI:1588365167
Name:PENTACARE HEALTH SERVICES
Entity type:Organization
Organization Name:PENTACARE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:OIGBOKIE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-C
Authorized Official - Phone:901-569-0208
Mailing Address - Street 1:10441 EMMAS CIR S
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-4186
Mailing Address - Country:US
Mailing Address - Phone:901-490-6211
Mailing Address - Fax:
Practice Address - Street 1:10441 EMMAS CIR S
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-4186
Practice Address - Country:US
Practice Address - Phone:901-490-6211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1033765730OtherCMS
TN1093247801OtherCMS