Provider Demographics
NPI:1336797992
Name:EXCEPTIONAL PHYSICIANS GROUP AMARILLO NORTH PLLC
Entity Type:Organization
Organization Name:EXCEPTIONAL PHYSICIANS GROUP AMARILLO NORTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAHBOUBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-533-0034
Mailing Address - Street 1:2101 S COULTER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2513
Practice Address - Country:US
Practice Address - Phone:817-755-7502
Practice Address - Fax:346-215-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty