1285671545 NPI number — OMAR HUSEIN MD

Table of content: OMAR HUSEIN MD (NPI 1285671545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285671545 NPI number — OMAR HUSEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSEIN
Provider First Name:
OMAR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1285671545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1424 N. MCDONALD ROAD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99216-1088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-928-7272
Provider Business Mailing Address Fax Number:
509-928-7346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1424 N. MCDONALD ROAD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-7272
Provider Business Practice Location Address Fax Number:
509-928-7346
Provider Enumeration Date:
06/02/2006

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: 207YX0905X , with the licence number:  35.083328 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8511792 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com