Healthcare Provider Details

I. General information

NPI: 1417414061
Provider Name (Legal Business Name): BLACKBURN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 GREENVILLE AVE STE 101
DALLAS TX
75231-5165
US

IV. Provider business mailing address

7150 GREENVILLE AVE STE 101
DALLAS TX
75231-5165
US

V. Phone/Fax

Practice location:
  • Phone: 214-613-0337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BASEM ABDELFATTAH
Title or Position: MANAGER
Credential: MD
Phone: 915-241-0997