Provider Demographics
NPI:1790100550
Name:DYNAMIC RPA HEALTHCARE PA
Entity Type:Organization
Organization Name:DYNAMIC RPA HEALTHCARE PA
Other - Org Name:DYNAMIC MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:INEAMA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:817-294-9600
Mailing Address - Street 1:6901 MCCART AVE
Mailing Address - Street 2:# 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6377
Mailing Address - Country:US
Mailing Address - Phone:817-294-9600
Mailing Address - Fax:817-294-9600
Practice Address - Street 1:6901 MCCART AVE
Practice Address - Street 2:# 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6377
Practice Address - Country:US
Practice Address - Phone:817-294-9600
Practice Address - Fax:817-294-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7354261QP2300X
TXPA05609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty