Provider Demographics
NPI:1134589047
Name:ROCKWALL HEALTH CENTER P.L.L.C
Entity type:Organization
Organization Name:ROCKWALL HEALTH CENTER P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMALABADI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-769-1009
Mailing Address - Street 1:2880 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5515
Mailing Address - Country:US
Mailing Address - Phone:469-769-1009
Mailing Address - Fax:469-769-1008
Practice Address - Street 1:2880 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5515
Practice Address - Country:US
Practice Address - Phone:469-769-1009
Practice Address - Fax:469-769-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10270302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477645778Medicare UPIN