Provider Demographics
NPI:1578040580
Name:NOAAK HEALTHCARE LLC
Entity Type:Organization
Organization Name:NOAAK HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:KHEN
Authorized Official - Last Name:ZAMA MBUH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:443-694-3931
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-0788
Mailing Address - Country:US
Mailing Address - Phone:817-382-0005
Mailing Address - Fax:682-334-7238
Practice Address - Street 1:4759 SOUTH FWY STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-3655
Practice Address - Country:US
Practice Address - Phone:817-382-0005
Practice Address - Fax:682-334-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty