Provider Demographics
NPI:1548385974
Name:GRAND PARKWAY FAMILY PRACTICE CLINIC,PA
Entity Type:Organization
Organization Name:GRAND PARKWAY FAMILY PRACTICE CLINIC,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-599-9979
Mailing Address - Street 1:707 S FRY RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2256
Mailing Address - Country:US
Mailing Address - Phone:281-599-9979
Mailing Address - Fax:281-599-3540
Practice Address - Street 1:707 S FRY RD
Practice Address - Street 2:SUITE 360
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2256
Practice Address - Country:US
Practice Address - Phone:281-599-9979
Practice Address - Fax:281-599-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0056MDOtherBCBS
TX170792901Medicaid
TX170792902Medicaid
LA1647870OtherUNISYS LOUISIANA MEDICAID
TX00161YMedicare PIN
TX170792902Medicaid