Provider Demographics
NPI:1396250577
Name:NORTH DALLAS HEALTHCARE ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTH DALLAS HEALTHCARE ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OUSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAMMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-471-2808
Mailing Address - Street 1:4040 LEGACY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4040 LEGACY DR STE 104
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6748
Practice Address - Country:US
Practice Address - Phone:469-200-8046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-09
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5873207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty