Provider Demographics
NPI:1508541384
Name:PARADISE MEDICAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:PARADISE MEDICAL MANAGEMENT LLC
Other - Org Name:PARADISE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISRAA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-732-2730
Mailing Address - Street 1:77 SUGAR CREEK CENTER BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3688
Mailing Address - Country:US
Mailing Address - Phone:832-990-6729
Mailing Address - Fax:
Practice Address - Street 1:13020 DAIRY ASHFORD RD STE 301
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4663
Practice Address - Country:US
Practice Address - Phone:713-732-2730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory