Provider Demographics
NPI:1932596004
Name:AHR MEDICAL GROUP PA
Entity Type:Organization
Organization Name:AHR MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1214-714-1663
Mailing Address - Street 1:4101 CENTURION WAY
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4347
Mailing Address - Country:US
Mailing Address - Phone:121-471-4166
Mailing Address - Fax:972-382-9992
Practice Address - Street 1:4101 CENTURION WAY
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4347
Practice Address - Country:US
Practice Address - Phone:121-471-4166
Practice Address - Fax:972-382-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05910208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty