1245438175 NPI number — CAMPBELL GHEBRANIOUS PLLC

Table of content: (NPI 1245438175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245438175 NPI number — CAMPBELL GHEBRANIOUS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMPBELL GHEBRANIOUS 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:
1245438175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10950 RESOURCE PKWY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77089-6134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-484-5587
Provider Business Mailing Address Fax Number:
281-464-6480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10950 RESOURCE PKWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77089-6134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-484-5587
Provider Business Practice Location Address Fax Number:
281-464-6480
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GHEBRANIOUS
Authorized Official First Name:
AMIR
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
281-484-5587

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  H4207 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: J9051 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00517K . This is a "BCBS TX PRACTICE ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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