Provider Demographics
NPI:1952810269
Name:GEBRMARIAM, NEGUSSIE AMSALE
Entity Type:Individual
Prefix:MR
First Name:NEGUSSIE
Middle Name:AMSALE
Last Name:GEBRMARIAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14908 TUFF RD
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-2217
Mailing Address - Country:US
Mailing Address - Phone:956-367-1967
Mailing Address - Fax:
Practice Address - Street 1:7610 CAMERON RD APT 2071
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-2050
Practice Address - Country:US
Practice Address - Phone:956-367-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
TX38828253172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)