Provider Demographics
NPI:1891208088
Name:PROFESSIONAL EHC EASTCHASE LLC
Entity Type:Organization
Organization Name:PROFESSIONAL EHC EASTCHASE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-375-1846
Mailing Address - Street 1:3514 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4901
Mailing Address - Country:US
Mailing Address - Phone:469-341-7800
Mailing Address - Fax:469-314-7887
Practice Address - Street 1:1251 EASTCHASE PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120
Practice Address - Country:US
Practice Address - Phone:817-566-0285
Practice Address - Fax:346-215-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty