Provider Demographics
NPI:1871329821
Name:EMPOWER CHILDREN'S CLINIC PA
Entity type:Organization
Organization Name:EMPOWER CHILDREN'S CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:OLUWAROTIMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEPOJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-775-5120
Mailing Address - Street 1:PO BOX 3132
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-3132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1230 FLORIDA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2378
Practice Address - Country:US
Practice Address - Phone:469-275-8915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty