1740535764 NPI number — KALIL AL-NASSIR, MD PA

Table of content: (NPI 1740535764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740535764 NPI number — KALIL AL-NASSIR, MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALIL AL-NASSIR, MD PA
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:
1740535764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 HIGHWAY 365
Provider Second Line Business Mailing Address:
SUITE 430
Provider Business Mailing Address City Name:
NEDERLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77627-6256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-727-6053
Provider Business Mailing Address Fax Number:
409-729-9793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 HIGHWAY 365
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
NEDERLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77627-6256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-727-6053
Provider Business Practice Location Address Fax Number:
409-729-9793
Provider Enumeration Date:
07/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
AL-NASSIR
Authorized Official First Name:
KALIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
409-724-6053

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P1443 . This is a "TEXAS LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1639303829 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".




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