1205968690 NPI number — ASHMEAD ALI M.D. PA

Table of content: (NPI 1205968690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205968690 NPI number — ASHMEAD ALI M.D. PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHMEAD ALI M.D. PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205968690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 ASCOT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNCANVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75116-2032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-283-3737
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 W WHEATLAND RD
Provider Second Line Business Practice Location Address:
SPECIAL CARE NURSERY
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237-3460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-283-3737
Provider Business Practice Location Address Fax Number:
972-283-3738
Provider Enumeration Date:
03/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALI
Authorized Official First Name:
ASHMEAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-283-3737

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  J1067 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)