Provider Demographics
NPI:1164842100
Name:MOOSA MHT LLC
Entity Type:Organization
Organization Name:MOOSA MHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-470-4740
Mailing Address - Street 1:1515 HERITAGE DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069
Mailing Address - Country:US
Mailing Address - Phone:855-860-2109
Mailing Address - Fax:
Practice Address - Street 1:1612 STONEY LAKE DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-6126
Practice Address - Country:US
Practice Address - Phone:855-860-2109
Practice Address - Fax:855-814-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty