Provider Demographics
NPI:1508942079
Name:AB MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:AB MEDICAL ASSOCIATES PA
Other - Org Name:IRVING HEALTH AND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-258-7838
Mailing Address - Street 1:2401 W AIRPORT FWY
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6016
Mailing Address - Country:US
Mailing Address - Phone:972-258-7838
Mailing Address - Fax:972-255-5819
Practice Address - Street 1:3989 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-5706
Practice Address - Country:US
Practice Address - Phone:972-258-0951
Practice Address - Fax:972-255-9975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELTLINE HEALTH AND MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8008261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH25EMedicare ID - Type UnspecifiedENTITY MEDICARE NUMBER