Provider Demographics
NPI:1205723574
Name:ATSABOUSSA KOUMBAS, RICCY C
Entity type:Individual
Prefix:
First Name:RICCY C
Middle Name:
Last Name:ATSABOUSSA KOUMBAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 COLONEL MCNALLY CV
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-2103
Mailing Address - Country:US
Mailing Address - Phone:737-781-2248
Mailing Address - Fax:
Practice Address - Street 1:505 COLONEL MCNALLY CV
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-2103
Practice Address - Country:US
Practice Address - Phone:737-781-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)Group - Single Specialty