Provider Demographics
NPI:1023103983
Name:EMMANUEL I MBAH
Entity type:Organization
Organization Name:EMMANUEL I MBAH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:MBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-764-9734
Mailing Address - Street 1:7411 HINES PLACE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235
Mailing Address - Country:US
Mailing Address - Phone:972-764-9734
Mailing Address - Fax:972-587-4909
Practice Address - Street 1:7411 HINES PLACE
Practice Address - Street 2:SUITE 225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:972-764-9734
Practice Address - Fax:972-587-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179756501Medicaid
TX179756502OtherMEDICAID
TX179756502OtherMEDICAID