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General NPI Number Information
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NPI Number | 1164954202
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Entity Type | Organization
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Legal Business Name | ETHAN EDDIE CHAMBLISS
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 4329 COUNTY ROAD 502D
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City | SWEENY
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State | TX
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Zip | 77480-8123
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Country | US
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Telephone | 180-088-4878
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Fax |
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Provider Business Mailing Address
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Address Line | 4329 COUNTY ROAD 502D
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City | SWEENY
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State | TX
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Zip | 77480-8123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COORIDINATOR
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Name | JASMINE JACKSON
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Credential |
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Telephone | 18008848788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 869576
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License Number State | TX
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