1801929450 NPI number — I-10 EAR NOSE AND THROAT PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801929450 NPI number — I-10 EAR NOSE AND THROAT PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
I-10 EAR NOSE AND THROAT 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:
6
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:
1801929450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 WESTMONT DR STE 445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77015-4368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-455-7555
Provider Business Mailing Address Fax Number:
713-455-7771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 WESTMONT DR STE 445
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:
77015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-455-7555
Provider Business Practice Location Address Fax Number:
713-455-7771
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOBRAN
Authorized Official First Name:
AMANI
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-455-7555

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 083125701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040006005 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 83T881 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 389996 . This is a "WELLCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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