Provider Demographics
NPI:1427673375
Name:IMD HEALTHCARE ASSOCIATION, INC.
Entity type:Organization
Organization Name:IMD HEALTHCARE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHI VI
Authorized Official - Middle Name:LE
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-522-2296
Mailing Address - Street 1:1125 EXECUTIVE CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2522
Mailing Address - Country:US
Mailing Address - Phone:817-522-2296
Mailing Address - Fax:
Practice Address - Street 1:5857 TORY DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8500
Practice Address - Country:US
Practice Address - Phone:817-522-2296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty