Provider Demographics
NPI:1316121254
Name:HAMID AHMADI MD PA
Entity type:Organization
Organization Name:HAMID AHMADI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-248-1159
Mailing Address - Street 1:PO BOX 795519
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-5519
Mailing Address - Country:US
Mailing Address - Phone:601-898-4400
Mailing Address - Fax:601-898-4404
Practice Address - Street 1:5820 COVEHAVEN DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5228
Practice Address - Country:US
Practice Address - Phone:601-898-4400
Practice Address - Fax:601-898-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4681246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0075KHOtherBLUE CROSS BLUE SHIELD
TX159996101Medicaid
TX00500VMedicare PIN