Provider Demographics
NPI:1093908204
Name:CHAMPIONS FAMILY PRACTICE, P.A
Entity Type:Organization
Organization Name:CHAMPIONS FAMILY PRACTICE, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALBIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:PUREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-376-2828
Mailing Address - Street 1:16740 CHAMPION FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7024
Mailing Address - Country:US
Mailing Address - Phone:281-376-2828
Mailing Address - Fax:281-320-8143
Practice Address - Street 1:16740 CHAMPION FOREST DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7024
Practice Address - Country:US
Practice Address - Phone:281-376-2828
Practice Address - Fax:281-320-8143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3405261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00070FMedicare PIN