Organization
MABANK MEDICAL CENTER,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAIM BANJO MD PHD (OWNER)
(903) 887-2161
Entity
Organization
Contact information
Practice address
802 W MASON, MABANK, TX 75147
(903) 887-2161
Mailing address
PO BOX 267, MABANK, TX 75147
(903) 887-2161
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G4442
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
081515101
—
TX
01
—
82G516
RENDERING PROVIDER #
TX
Enumeration date
10/17/2006
Last updated
01/05/2011
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