Healthcare Provider Details

I. General information

NPI: 1740672914
Provider Name (Legal Business Name): SIRUIUS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HOLDERRIETH BLVD
TOMBALL TX
77375-6445
US

IV. Provider business mailing address

PO BOX 1568
TOMBALL TX
77377-1568
US

V. Phone/Fax

Practice location:
  • Phone: 281-401-7617
  • Fax:
Mailing address:
  • Phone: 281-357-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. MARWAN ASIA NASIR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 281-401-7617