Provider Demographics
NPI:1528130937
Name:SIDNEY ONTAI MD ASSOCIATION
Entity type:Organization
Organization Name:SIDNEY ONTAI MD ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ONTAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-293-2270
Mailing Address - Street 1:2606 YONKERS ST
Mailing Address - Street 2:STE 4
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-1851
Mailing Address - Country:US
Mailing Address - Phone:806-293-2270
Mailing Address - Fax:806-293-5698
Practice Address - Street 1:2606 YONKERS ST
Practice Address - Street 2:STE 4
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1851
Practice Address - Country:US
Practice Address - Phone:806-293-2270
Practice Address - Fax:806-293-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0059DKOtherBLUE CROSS
TX00194JMedicare ID - Type Unspecified