Provider Demographics
NPI:1417414061
Name:BLACKBURN MANAGEMENT
Entity Type:Organization
Organization Name:BLACKBURN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELFATTAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-241-0997
Mailing Address - Street 1:7150 GREENVILLE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7150 GREENVILLE AVE STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5165
Practice Address - Country:US
Practice Address - Phone:214-613-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty