1396757233 NPI number — DR. HAMED ABDULSALAM SHABANEH AL-TAMIMI M.D.

Table of content: DR. HAMED ABDULSALAM SHABANEH AL-TAMIMI M.D. (NPI 1396757233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396757233 NPI number — DR. HAMED ABDULSALAM SHABANEH AL-TAMIMI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHABANEH AL-TAMIMI
Provider First Name:
HAMED
Provider Middle Name:
ABDULSALAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AL-TAMIMI
Provider Other First Name:
HAMED
Provider Other Middle Name:
ABDULSALAM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396757233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79490-6770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-701-5797
Provider Business Mailing Address Fax Number:
806-701-5798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2345 50TH ST # 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79412-2565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-701-5797
Provider Business Practice Location Address Fax Number:
806-701-5798
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  M8330 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: MD00042678 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200072300A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202003136 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92629083 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147548101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8M0735 . This is a "HMO BLUE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8U5052 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 147548100 . This is a "FIRSTCARE COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 179160001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202003136 . This is a "PRESBYTERIAN COMMERCIAL" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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