1588747166 NPI number — NABIL GUIRGUIS

Table of content: (NPI 1588747166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588747166 NPI number — NABIL GUIRGUIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NABIL GUIRGUIS
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:
KIDNEY DIALYSIS & TRANSPLANT GROUP
Provider Other Organization Name Type Code:
5
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:
1588747166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 THOMPSON DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26330-1644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-842-5668
Provider Business Mailing Address Fax Number:
304-842-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 THOMPSON DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26330-1644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-842-5668
Provider Business Practice Location Address Fax Number:
304-842-3113
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUIRGUIS
Authorized Official First Name:
AMAL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGING EMPLOYEE
Authorized Official Telephone Number:
304-629-9399

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001934214 . This is a "BLUE CROSS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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