1497829659 NPI number — SURA SHARQE ENDOCRINOLOGY, INC

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 1497829659 NPI number — SURA SHARQE ENDOCRINOLOGY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURA SHARQE ENDOCRINOLOGY, INC
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:
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:
1497829659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 72327
Provider Second Line Business Mailing Address:
SURA SHARQE ENDOCRINOLOGY, INC
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85050-1023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-825-0237
Provider Business Mailing Address Fax Number:
480-361-1503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6525 W. SACK DRIVE
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-825-0237
Provider Business Practice Location Address Fax Number:
623-825-0271
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GABIR
Authorized Official First Name:
MOMIN
Authorized Official Middle Name:
MOHAMED
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
623-825-0237

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 28217 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 56505401 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 565054 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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