Provider Demographics
NPI:1639308539
Name:INNOVATIVE EMERGENCY PHYSICIANS OF SUNNYVALE PA
Entity Type:Organization
Organization Name:INNOVATIVE EMERGENCY PHYSICIANS OF SUNNYVALE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-906-9398
Mailing Address - Street 1:9 HARBOUR TOWN CT
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6819
Mailing Address - Country:US
Mailing Address - Phone:877-485-4474
Mailing Address - Fax:
Practice Address - Street 1:231 S COLLINS RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4624
Practice Address - Country:US
Practice Address - Phone:214-906-9398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208113501Medicaid
616483OtherDEPT OF LABOR FECA OWCP
TXDQ5606OtherRRMCARE
TX208113501Medicaid