1568718344 NPI number — MARIO FAHMY BISHARA SEMAAN FADILA M.B.CH.B.

Table of content: MARIO FAHMY BISHARA SEMAAN FADILA M.B.CH.B. (NPI 1568718344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568718344 NPI number — MARIO FAHMY BISHARA SEMAAN FADILA M.B.CH.B.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FADILA
Provider First Name:
MARIO
Provider Middle Name:
FAHMY BISHARA SEMAAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.B.CH.B.
Provider Gender Code:
M

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:
1568718344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16222 W US HIGHWAY 24 STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND PARK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80863-8763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-686-2832
Provider Business Mailing Address Fax Number:
719-686-2833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
DC043.00
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
66212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-882-0808
Provider Business Practice Location Address Fax Number:
573-882-8788
Provider Enumeration Date:
07/30/2012

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: DR.0058664 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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