NPIMap

Organization Active NPI

Benedict Olusola MD PA

  • Specialist
  • Desoto, TX
National Provider Identifier
1396833125
Registry record updated Sep 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
BENEDICT OLUSOLA MD PA
Practice address
1700 N Hampton Rd
Ste 100
Desoto, TX 75115-2392
Phone
(972) 228-3677
Fax
(972) 228-3672
NPI assigned
Oct 10, 2006
Last updated
Sep 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2012

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

Authorized official

Name
Marvella L Powell, MBA
Title
Office Manager
Phone
(972) 228-3677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

1700 N Hampton Rd
Ste 100
Desoto, TX 75115-2392

Mailing address

PO Box 628
Desoto, TX 75115-8302
Phone (972) 228-3677

National Provider Directory

National Provider Directory

Locations

1700 N Hampton Rd
Ste 100
Desoto, TX 75115
Phone (972) 228-3677

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347926400000",
    "number": "1396833125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 628",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751158302",
            "telephone_number": "972-228-3677",
            "fax_number": "972-228-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N HAMPTON RD",
            "address_2": "STE 100",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152392",
            "telephone_number": "972-228-3677",
            "fax_number": "972-228-3672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENEDICT OLUSOLA MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2012-09-18",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "MARVELLA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "972-228-3677",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.