1366689879 NPI number — PACHIE SABUGA CHAN M.D.P.A

Table of content: (NPI 1366689879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366689879 NPI number — PACHIE SABUGA CHAN M.D.P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACHIE SABUGA CHAN M.D.P.A
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:
1366689879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19073 INTERSTATE 45 S
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
SHENANDOAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77385-8743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-271-2227
Provider Business Mailing Address Fax Number:
936-271-2229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19073 INTERSTATE 45 S
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77385-8743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-271-2227
Provider Business Practice Location Address Fax Number:
936-271-2229
Provider Enumeration Date:
01/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHAN
Authorized Official First Name:
PACHIE
Authorized Official Middle Name:
SABUGA
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
936-271-2227

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  K6286 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 154457901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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