Provider Demographics
NPI:1487171898
Name:SAMB PLLC
Entity type:Organization
Organization Name:SAMB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BINDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-453-2123
Mailing Address - Street 1:2360 HIGHWAY 157 N
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7540
Mailing Address - Country:US
Mailing Address - Phone:817-453-2123
Mailing Address - Fax:817-453-2151
Practice Address - Street 1:2360 HIGHWAY 157 N
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7540
Practice Address - Country:US
Practice Address - Phone:973-928-0521
Practice Address - Fax:817-549-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606539OtherMEDICARE