Provider Demographics
NPI:1982399358
Name:HAREGOT, ABRHA KAHSAAY
Entity Type:Individual
Prefix:
First Name:ABRHA
Middle Name:KAHSAAY
Last Name:HAREGOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ABRHA
Other - Middle Name:KAHSAAY
Other - Last Name:HAREGOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AZHALA
Mailing Address - Street 1:2301 PERFORMANCE DR APT 455
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4541
Mailing Address - Country:US
Mailing Address - Phone:512-566-9881
Mailing Address - Fax:512-358-4017
Practice Address - Street 1:2301 PERFORMANCE DR APT 455
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4541
Practice Address - Country:US
Practice Address - Phone:512-566-9881
Practice Address - Fax:512-358-4017
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343800000X
343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88-2045428OtherTRANSPORTATION
TX1043968738OtherTRANSPORTATION
TX1043968738Medicaid