Provider Demographics
NPI:1013549831
Name:EID, JABER, JASSAR, PLLC
Entity Type:Organization
Organization Name:EID, JABER, JASSAR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-636-1900
Mailing Address - Street 1:1717 OLYMPIA WAY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3929
Mailing Address - Country:US
Mailing Address - Phone:360-636-1900
Mailing Address - Fax:
Practice Address - Street 1:1461 NW LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1749
Practice Address - Country:US
Practice Address - Phone:360-636-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EID, JABER, JASSAR, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5045687Medicaid