Provider Demographics
NPI:1922010479
Name:LYDIA O. NJAMFA, MD.PA
Entity Type:Organization
Organization Name:LYDIA O. NJAMFA, MD.PA
Other - Org Name:COMMUNITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:OLUWATOYIN
Authorized Official - Last Name:NJAMFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-570-9400
Mailing Address - Street 1:708 W SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7216
Mailing Address - Country:US
Mailing Address - Phone:214-570-9400
Mailing Address - Fax:972-792-7246
Practice Address - Street 1:708 W SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7216
Practice Address - Country:US
Practice Address - Phone:214-570-9400
Practice Address - Fax:972-792-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10017340OtherAMERIGROUP
TX1703118-02Medicaid
TX1703118-01Medicaid
TX1703118-02Medicaid
TX00509HMedicare ID - Type Unspecified