1003812595 NPI number — NIRAN JAN AMAR M.D.

Table of content: (NPI 1083638688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003812595 NPI number — NIRAN JAN AMAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMAR
Provider First Name:
NIRAN
Provider Middle Name:
JAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1003812595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 LONDONDERRY DRIVE SUITE # 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-751-1144
Provider Business Mailing Address Fax Number:
254-751-1185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 LONDONDERRY DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76712-7930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-751-1144
Provider Business Practice Location Address Fax Number:
254-751-1185
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207KI0005X , with the licence number:  G2305 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: G2305 , 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)

  • Identifier: 19715 . This is a "SCOTT & WHITE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 107463100 . This is a "FIRST CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88290Y . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 030001522 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100242002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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