Provider Demographics
NPI:1932488020
Name:ABA MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:ABA MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEOLA
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AMUSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:469-200-4118
Mailing Address - Street 1:502 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2836
Mailing Address - Country:US
Mailing Address - Phone:469-200-4115
Mailing Address - Fax:469-200-4118
Practice Address - Street 1:502 E HIGH ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2836
Practice Address - Country:US
Practice Address - Phone:469-200-4115
Practice Address - Fax:469-200-4118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1515302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization