1891787115 NPI number — DR. ANTHONY O. GAMBRAH SAMPANEY MD. FACP

Table of content: DR. ANTHONY O. GAMBRAH SAMPANEY MD. FACP (NPI 1891787115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891787115 NPI number — DR. ANTHONY O. GAMBRAH SAMPANEY MD. FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAMBRAH SAMPANEY
Provider First Name:
ANTHONY
Provider Middle Name:
O.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD. FACP
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:
1891787115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20477
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77720-0477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-729-7030
Provider Business Mailing Address Fax Number:
409-729-7015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7980 ANCHOR DR
Provider Second Line Business Practice Location Address:
BUILDING 400
Provider Business Practice Location Address City Name:
PORT ARTHUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77642-8266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-729-7030
Provider Business Practice Location Address Fax Number:
409-729-7015
Provider Enumeration Date:
08/22/2005

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: 207R00000X , with the licence number:  J9675 , 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: 143474801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com