Provider Demographics
NPI:1205026432
Name:RHEUMATOLOGY ASSOCIATION OF LONGVIEW, PLLC
Entity type:Organization
Organization Name:RHEUMATOLOGY ASSOCIATION OF LONGVIEW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-236-7020
Mailing Address - Street 1:920 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601
Mailing Address - Country:US
Mailing Address - Phone:903-236-7020
Mailing Address - Fax:903-236-7093
Practice Address - Street 1:920 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-236-7020
Practice Address - Fax:903-236-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160966101Medicaid
TX160966101Medicaid