Basic Information
| Provider Information | |||||||||
| NPI: | 1366869380 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PYRAMID PHYSICIAN SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2680 INDIAN RIPPLE RD | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454403605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377051368 | ||||||||
| FaxNumber: | 9372985596 | ||||||||
| Practice Location | |||||||||
| Address1: | 2680 INDIAN RIPPLE RD | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454403605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377051368 | ||||||||
| FaxNumber: | 9372985596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2014 | ||||||||
| LastUpdateDate: | 09/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | AKBIK | ||||||||
| AuthorizedOfficialFirstName: | HAMMAM | ||||||||
| AuthorizedOfficialMiddleName: | HADI | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9377051368 | ||||||||
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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 | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0104990 | 05 | OH | MEDICAID |