=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003257304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BASIOUNI HEALTHCARE ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2013
-----------------------------------------------------
Last Update Date | 07/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1109 PAMELA DR
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-4340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-585-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1109 PAMELA DR
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78572-4340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD OWNER
-----------------------------------------------------
Name | DR. BASIOUNI BASIOUNI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 956-639-3084
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | N1543
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------