Provider Demographics
NPI:1063430932
Name:AMJAD RASS, INC
Entity type:Organization
Organization Name:AMJAD RASS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RASS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-435-8585
Mailing Address - Street 1:1730 SOUTHGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3024
Mailing Address - Country:US
Mailing Address - Phone:740-435-8585
Mailing Address - Fax:740-454-3790
Practice Address - Street 1:1730 SOUTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3024
Practice Address - Country:US
Practice Address - Phone:740-435-8585
Practice Address - Fax:740-454-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD6530OtherRR M/C GROUP PROV #
OH2612935Medicaid
OH2612935Medicaid
OHDD6530OtherRR M/C GROUP PROV #