Provider Demographics
NPI:1255004495
Name:EBN PHYSICIAN SERVICES, PLLC
Entity Type:Organization
Organization Name:EBN PHYSICIAN SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMEKE
Authorized Official - Middle Name:B
Authorized Official - Last Name:NWABUZOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-351-8769
Mailing Address - Street 1:402A W PALM VALLEY BLVD # 310
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4237
Mailing Address - Country:US
Mailing Address - Phone:512-351-8769
Mailing Address - Fax:
Practice Address - Street 1:700 SE INNER LOOP
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7700
Practice Address - Country:US
Practice Address - Phone:512-819-9400
Practice Address - Fax:512-240-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty