Provider Demographics
NPI:1679945539
Name:URBAN HEALTH SYSTEMS P.A.
Entity Type:Organization
Organization Name:URBAN HEALTH SYSTEMS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-337-4700
Mailing Address - Street 1:7310 S WESTMORELAND RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3002
Mailing Address - Country:US
Mailing Address - Phone:214-337-4700
Mailing Address - Fax:972-709-2847
Practice Address - Street 1:7310 S WESTMORELAND RD STE 1
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3002
Practice Address - Country:US
Practice Address - Phone:214-337-4700
Practice Address - Fax:972-709-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6395207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
472310OtherMEDICARE ID
TX032574801Medicaid
00CW90OtherMEDICARE ID
00CW90OtherMEDICARE ID