Provider Demographics
NPI:1477199685
Name:BLACKBURN PROCUREMENT LLC
Entity Type:Organization
Organization Name:BLACKBURN PROCUREMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BASEM
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:ABDELFATTAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-390-7697
Mailing Address - Street 1:PO BOX 250783
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0783
Mailing Address - Country:US
Mailing Address - Phone:214-390-7697
Mailing Address - Fax:888-770-6360
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:214-390-7697
Practice Address - Fax:888-770-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty