Provider Demographics
NPI:1982906244
Name:CITYWIDE I D ASSOCIATES, INC
Entity Type:Organization
Organization Name:CITYWIDE I D ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:REUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-282-7692
Mailing Address - Street 1:15800 DOOLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4284
Mailing Address - Country:US
Mailing Address - Phone:972-239-3849
Mailing Address - Fax:972-934-4969
Practice Address - Street 1:15800 DOOLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4284
Practice Address - Country:US
Practice Address - Phone:972-239-3849
Practice Address - Fax:972-934-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty