=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093294746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAHAM TOMBALL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2018
-----------------------------------------------------
Last Update Date | 01/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 ALMA ST STE 104
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-503-1711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 ALMA ST STE 108
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-503-1711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SAAD ALSAAB
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 646-592-1337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 291U00000X
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------