Basic Information
| Provider Information | |||||||||
| NPI: | 1316189772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHASAWNEH | ||||||||
| FirstName: | FAISAL | ||||||||
| MiddleName: | ABDULAH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 WALLACE BLVD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791061708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064149100 | ||||||||
| FaxNumber: | 8063545717 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 S COULTER ST | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791061786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064149100 | ||||||||
| FaxNumber: | 8063545717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 09/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | N0885 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RI0200X | N0885 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RC0200X | 036-137287 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RI0200X | 036-137287 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 205544402 | 05 | TX | MEDICAID | 205544401 | 05 | TX | MEDICAID | 200268610 A | 05 | OK | MEDICAID | 00754366 | 05 | NM | MEDICAID |