Iconic Healthcare Services Co.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

ICONIC HEALTHCARE SERVICES CO.

Practice address

17045 El Camino Real Ste 218
Houston, TX 77058-2644

Phone

(281) 461-4000

Fax

(281) 204-9040

NPI assigned

Jul 9, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Wilfred Usi Ajayi, MD., PHD.

Title

President/Ceo

Phone

(281) 901-8950

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344297600000",
    "number": "1205148079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17045 EL CAMINO REAL, SUITE 218",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17045 EL CAMINO REAL STE 218",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582644",
            "telephone_number": "281-461-4000",
            "fax_number": "281-204-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICONIC HEALTHCARE SERVICES CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-09",
        "last_updated": "2012-08-07",
        "status": "A",
        "authorized_official_last_name": "AJAYI",
        "authorized_official_first_name": "WILFRED",
        "authorized_official_middle_name": "USI",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "281-901-8950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD., PHD."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "289023801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.