Provider Demographics
NPI:1578176194
Name:NOYDEEN MEDICAL GROUP- RUSSELLVILLE
Entity Type:Organization
Organization Name:NOYDEEN MEDICAL GROUP- RUSSELLVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-209-4040
Mailing Address - Street 1:1605 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2719
Mailing Address - Country:US
Mailing Address - Phone:479-219-5008
Mailing Address - Fax:479-219-5025
Practice Address - Street 1:1605 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2719
Practice Address - Country:US
Practice Address - Phone:479-219-5008
Practice Address - Fax:479-219-5025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOYDEEN SISTERS MEDICAL GROUP & CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty