1609188846 NPI number — DR. NOURELHODA IBRAHIM FARAH M.D

Table of content: DONDRIA RACHELLE HOLLIES FNP-BC (NPI 1194712844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609188846 NPI number — DR. NOURELHODA IBRAHIM FARAH M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARAH
Provider First Name:
NOURELHODA
Provider Middle Name:
IBRAHIM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARAH
Provider Other First Name:
NOUR
Provider Other Middle Name:
IBRAHIM
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609188846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11511 SHADOW CREEK PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-7298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-442-0000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2727 W HOLCOMBE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77025-1669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-442-0000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2010

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: 208000000X , with the licence number:  T-2307 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: R0227 , 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: 363729003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 363729004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09870733 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 363729005 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".