1639203276 NPI number — FADY F JABRE MD

Table of content: FADY F JABRE MD (NPI 1639203276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639203276 NPI number — FADY F JABRE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JABRE
Provider First Name:
FADY
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639203276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2720 STONE PARK BLVD
Provider Second Line Business Mailing Address:
UNITY POINT HEALTH - ST. LUKE'S
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51104-3734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-279-3500
Provider Business Mailing Address Fax Number:
820-275-3756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 STONE PARK BLVD
Provider Second Line Business Practice Location Address:
UNITY POINT HEALTH - ST. LUKE'S
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51104-3734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-279-3500
Provider Business Practice Location Address Fax Number:
620-272-2293
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  0426398 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 39462 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 0426398 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00753162 . This is a "RAILROAD MCARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 054539 . This is a "BCBS THRU ST CATS ER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100268820B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100268820D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 930086611 . This is a "RAILROAD THRU ST CATS ER" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100268820F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100268820G , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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