1174147086 NPI number — NORTH TEXAS GENERAL SURGERY PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174147086 NPI number — NORTH TEXAS GENERAL SURGERY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS GENERAL SURGERY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1174147086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3208 AMBER WAVES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYLIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75098-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
945-205-0333
Provider Business Mailing Address Fax Number:
945-205-0444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 S CENTRAL EXPY STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75080-7439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
945-205-0333
Provider Business Practice Location Address Fax Number:
945-205-0444
Provider Enumeration Date:
06/05/2020

Additional Information

Authorized Official

Authorized Official Last Name:
IBRAHIM
Authorized Official First Name:
MOHAMED
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
945-205-0333

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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