Basic Information
| Provider Information | |||||||||
| NPI: | 1194763383 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEXAS PREMIER INTERNAL MEDICINE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARLINGTON INPATIENT PHYSICIANS, P.A. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909A MEDICAL CENTRE DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760124757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172745580 | ||||||||
| FaxNumber: | 8172745540 | ||||||||
| Practice Location | |||||||||
| Address1: | 909A MEDICAL CENTRE DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760124757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172745580 | ||||||||
| FaxNumber: | 8172745540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 11/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | FORDJOUR | ||||||||
| AuthorizedOfficialFirstName: | KUSI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8172745580 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0082MW | 01 | TX | BLUE CROSS BLUE SHEILD | OTHER |