Provider Demographics
NPI:1154048288
Name:AHMED ELAHMADY PC
Entity type:Organization
Organization Name:AHMED ELAHMADY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOUTAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTOB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:563-244-2144
Mailing Address - Street 1:2745 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-7201
Mailing Address - Country:US
Mailing Address - Phone:563-244-2144
Mailing Address - Fax:563-244-2143
Practice Address - Street 1:2745 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7201
Practice Address - Country:US
Practice Address - Phone:563-505-7537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHMED ELAHMADY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-19
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty