Provider Demographics
NPI:1003288879
Name:ZIMA MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:ZIMA MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBINNA
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:OZIBGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-241-7562
Mailing Address - Street 1:12030 BANDERA RD
Mailing Address - Street 2:STE. 128
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4735
Mailing Address - Country:US
Mailing Address - Phone:210-685-8111
Mailing Address - Fax:210-569-6581
Practice Address - Street 1:12030 BANDERA RD
Practice Address - Street 2:STE. 128
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4735
Practice Address - Country:US
Practice Address - Phone:210-685-8111
Practice Address - Fax:210-569-6581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid