Provider Demographics
NPI:1063758050
Name:TEXAS FIRST HOUSECALL ASSOCIATES INC
Entity type:Organization
Organization Name:TEXAS FIRST HOUSECALL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ZAINABU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROMA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:972-467-2249
Mailing Address - Street 1:3201 INTERSTATE 30
Mailing Address - Street 2:SUITE H
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2605
Mailing Address - Country:US
Mailing Address - Phone:972-677-7564
Mailing Address - Fax:972-677-7419
Practice Address - Street 1:3201 INTERSTATE 30
Practice Address - Street 2:SUITE H
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2605
Practice Address - Country:US
Practice Address - Phone:972-677-7564
Practice Address - Fax:972-677-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3228108Medicaid