Basic Information
| Provider Information | |||||||||
| NPI: | 1235459553 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN ACCESS CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 716 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022389911 | ||||||||
| FaxNumber: | 5022389912 | ||||||||
| Practice Location | |||||||||
| Address1: | 716 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022389911 | ||||||||
| FaxNumber: | 5022389912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2010 | ||||||||
| LastUpdateDate: | 06/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | BURIDI | ||||||||
| AuthorizedOfficialFirstName: | ABDUL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5022389911 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.