1952864738 NPI number — GAUKHAR ERZHANOVNA AMANDOSSOVA

Table of content: GAUKHAR ERZHANOVNA AMANDOSSOVA (NPI 1952864738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952864738 NPI number — GAUKHAR ERZHANOVNA AMANDOSSOVA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMANDOSSOVA
Provider First Name:
GAUKHAR
Provider Middle Name:
ERZHANOVNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1952864738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79430-8103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-743-6744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TCH WOODLANDS-OUTPATIENT SERVICES
Provider Second Line Business Practice Location Address:
17580 INTERSTATE 45
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-822-4897
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2019

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: 2084P0804X , with the licence number:  V1392 , 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)





Copyright © 2007-2025 www.npivalidator.com