Provider Demographics
NPI:1477942613
Name:OPTIMED HOSPITALISTS, PLLC
Entity Type:Organization
Organization Name:OPTIMED HOSPITALISTS, PLLC
Other - Org Name:OPTIMED SPECIALTY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:AJJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-960-8182
Mailing Address - Street 1:P.O. BOX 2530
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-2530
Mailing Address - Country:US
Mailing Address - Phone:980-259-2498
Mailing Address - Fax:704-997-5525
Practice Address - Street 1:108 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8096
Practice Address - Country:US
Practice Address - Phone:980-259-2498
Practice Address - Fax:704-997-5525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMED HOSPITALISTS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-12
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207PE0005X, 207R00000X, 208M00000X
NC207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2348036OtherMEDICARE
NC1477942613Medicaid
NC023XEOtherBLUE CROSS