Provider Demographics
NPI:1790896868
Name:TEXOMA MEDICAL CENTER JOINT VENTURE
Entity Type:Organization
Organization Name:TEXOMA MEDICAL CENTER JOINT VENTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIAKBAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHTAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-322-2244
Mailing Address - Street 1:1518 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4405
Mailing Address - Country:US
Mailing Address - Phone:940-322-2244
Mailing Address - Fax:940-322-5511
Practice Address - Street 1:1518 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4405
Practice Address - Country:US
Practice Address - Phone:940-322-2244
Practice Address - Fax:940-322-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR27777261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTXUV12Medicare PIN