Organization
ETHAN EDDIE CHAMBLISS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASMINE JACKSON (COORIDINATOR)
18008848788
Entity
Organization
Contact information
Practice address
4329 COUNTY ROAD 502D, SWEENY, TX 77480-8123
(180) 088-4878
Mailing address
4329 COUNTY ROAD 502D, SWEENY, TX 77480-8123
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
869576
TX
Other
Enumeration date
03/29/2017
Last updated
03/29/2017
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