Provider Demographics
NPI:1831458132
Name:CENTENNIAL PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:CENTENNIAL PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NUZHAT
Authorized Official - Middle Name:F
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-656-1050
Mailing Address - Street 1:5520 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-4606
Mailing Address - Country:US
Mailing Address - Phone:214-383-0001
Mailing Address - Fax:214-383-0068
Practice Address - Street 1:5520 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4606
Practice Address - Country:US
Practice Address - Phone:214-383-0001
Practice Address - Fax:214-383-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty