Basic Information
Provider Information | |||||||||
NPI: | 1487083200 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MBM ASSISTING LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 9490 FM 1960 BYPASS W. STE. 200-310 | ||||||||
Address2: |   | ||||||||
City: | HUMBLE | ||||||||
State: | TX | ||||||||
PostalCode: | 773383962 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8327718363 | ||||||||
FaxNumber: | 8324910322 | ||||||||
Practice Location | |||||||||
Address1: | 9490 FM 1960 BYPASS W. STE. 200-310 | ||||||||
Address2: |   | ||||||||
City: | HUMBLE | ||||||||
State: | TX | ||||||||
PostalCode: | 773383962 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8327718363 | ||||||||
FaxNumber: | 8324910322 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/02/2013 | ||||||||
LastUpdateDate: | 11/02/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CURD | ||||||||
AuthorizedOfficialFirstName: | KARLEY | ||||||||
AuthorizedOfficialMiddleName: | ANNE | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/MANAGER | ||||||||
AuthorizedOfficialTelephone: | 8327718363 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.