Provider Demographics
NPI:1225786122
Name:HAMED ABDULSALAM SHABANEH ALTAMIMI MD, PLLC
Entity Type:Organization
Organization Name:HAMED ABDULSALAM SHABANEH ALTAMIMI MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHABANEH ALTAMIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-441-9495
Mailing Address - Street 1:PO BOX 16770
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79490-6770
Mailing Address - Country:US
Mailing Address - Phone:806-701-5797
Mailing Address - Fax:806-701-5798
Practice Address - Street 1:2345 50TH ST STE 500
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2565
Practice Address - Country:US
Practice Address - Phone:806-701-5797
Practice Address - Fax:806-701-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty