Provider Demographics
NPI:1083829527
Name:KIFLE ADMASSU MD PA
Entity Type:Organization
Organization Name:KIFLE ADMASSU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIFLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADMASSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-960-6648
Mailing Address - Street 1:305 HAWKS RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-8213
Mailing Address - Country:US
Mailing Address - Phone:817-960-6648
Mailing Address - Fax:817-960-6649
Practice Address - Street 1:305 HAWKS RIDGE TRL
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8213
Practice Address - Country:US
Practice Address - Phone:817-960-6648
Practice Address - Fax:817-960-6649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM1448OtherLICENSE
TX00X656OtherNEW MEDICARE NUMBER
TX612406OtherOTHER MEDICARE #
TX00X656OtherNEW MEDICARE NUMBER
TX=========OtherEIN
TXI42753Medicare UPIN