# ETHAN EDDIE CHAMBLISS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164954202
- **Authorized official:** JASMINE JACKSON (COORIDINATOR)
- **Authorized official phone:** 18008848788

## Contact information

- **Practice address:** 4329 COUNTY ROAD 502D, SWEENY, TX 77480-8123
- **Practice address phone:** (180) 088-4878
- **Mailing address:** 4329 COUNTY ROAD 502D, SWEENY, TX 77480-8123

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 869576 | TX | Yes |

## Other

- **Enumeration date:** 03/29/2017
- **Last updated:** 03/29/2017