Provider Demographics
NPI:1174708564
Name:PEARLAND ENT PA
Entity type:Organization
Organization Name:PEARLAND ENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD-PHD
Authorized Official - Phone:281-412-6100
Mailing Address - Street 1:2225 COUNTY ROAD 90
Mailing Address - Street 2:SUITE 123
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4890
Mailing Address - Country:US
Mailing Address - Phone:281-412-6100
Mailing Address - Fax:281-412-2423
Practice Address - Street 1:2225 COUNTY ROAD 90 STE 123
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4891
Practice Address - Country:US
Practice Address - Phone:281-412-6100
Practice Address - Fax:281-412-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161137801Medicaid
TX00587VMedicare PIN