Provider Demographics
NPI:1922523042
Name:BNA MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:BNA MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:NIMAN
Authorized Official - Last Name:ALSHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-573-1774
Mailing Address - Street 1:3515 ARISTA BLVD APT 27
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1196
Mailing Address - Country:US
Mailing Address - Phone:973-573-1774
Mailing Address - Fax:
Practice Address - Street 1:150 BRAND RD STE 700
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-3734
Practice Address - Country:US
Practice Address - Phone:469-445-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP05342084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNOT SURE