1477693711 NPI number — FAHNBULLEH INFECTIOUS DISEASE CONSULTANTS P A

Table of content: (NPI 1477693711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477693711 NPI number — FAHNBULLEH INFECTIOUS DISEASE CONSULTANTS P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAHNBULLEH INFECTIOUS DISEASE CONSULTANTS P A
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:
HOUSTON COMMUNITY ID ASSOC.
Provider Other Organization Name Type Code:
3
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:
1477693711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 941478
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77094-8478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-979-0251
Provider Business Mailing Address Fax Number:
713-987-0404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9601 KATY FREEWAY
Provider Second Line Business Practice Location Address:
STE 260
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77024-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-979-0251
Provider Business Practice Location Address Fax Number:
713-987-0404
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FAHNBULLEH
Authorized Official First Name:
AUGUSTUS
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
SOLE PROP.
Authorized Official Telephone Number:
713-979-0251

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 169653601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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