1255410940 NPI number — ZOUHEIR FARES

Table of content: (NPI 1255410940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255410940 NPI number — ZOUHEIR FARES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZOUHEIR FARES
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:
BEECHER SURGICAL ASSOCIATES
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:
1255410940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/28/2007
NPI Reactivation Date:
10/11/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8384 HOLLY RD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-1974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-733-8400
Provider Business Mailing Address Fax Number:
810-733-2634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8384 HOLLY RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-1976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-733-8400
Provider Business Practice Location Address Fax Number:
810-733-2634
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARES
Authorized Official First Name:
ZOUHEIR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
810-733-8400

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  5101008104 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0252501065 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1931600 . This is a "TYPE 11" identifier , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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