Provider Demographics
NPI:1265551402
Name:ABILENE INTERNIST AND ASSOCIATES PA
Entity type:Organization
Organization Name:ABILENE INTERNIST AND ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRAMESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-860-1400
Mailing Address - Street 1:620 MATLOCK CENTER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2536
Mailing Address - Country:US
Mailing Address - Phone:817-860-1400
Mailing Address - Fax:214-221-5400
Practice Address - Street 1:620 MATLOCK CENTER CIRCLE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2536
Practice Address - Country:US
Practice Address - Phone:817-860-1400
Practice Address - Fax:214-221-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081248902Medicaid
TX081248901Medicaid
TX00843KMedicare PIN
TX00862VMedicare PIN