1982164133 NPI number — AWAAM PRIMARY CARE CLINIC LLC

Table of content: (NPI 1982164133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982164133 NPI number — AWAAM PRIMARY CARE CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AWAAM PRIMARY CARE CLINIC LLC
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:
1982164133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 FM 2218 RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77469-5419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-400-2344
Provider Business Mailing Address Fax Number:
832-400-2345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 FM 2218 RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77469-5419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-857-1608
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WAHEED
Authorized Official First Name:
ABDUL
Authorized Official Middle Name:
Authorized Official Title or Position:
FNP-BC
Authorized Official Telephone Number:
832-400-2344

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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