Provider Demographics
NPI:1811267727
Name:INNOVATED MINDS PA
Entity type:Organization
Organization Name:INNOVATED MINDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:QUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-684-2710
Mailing Address - Street 1:1029 LONG PRAIRIE RD
Mailing Address - Street 2:STE D
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4243
Mailing Address - Country:US
Mailing Address - Phone:817-684-2710
Mailing Address - Fax:972-724-2111
Practice Address - Street 1:1029 LONG PRAIRIE RD
Practice Address - Street 2:STE D
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4243
Practice Address - Country:US
Practice Address - Phone:817-684-2710
Practice Address - Fax:972-724-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)