Healthcare Provider Details

I. General information

NPI: 1891208088
Provider Name (Legal Business Name): PROFESSIONAL EHC EASTCHASE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 01/17/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 EASTCHASE PKWY
FORT WORTH TX
76120
US

IV. Provider business mailing address

3514 CEDAR SPRINGS RD
DALLAS TX
75219-4901
US

V. Phone/Fax

Practice location:
  • Phone: 817-566-0285
  • Fax: 346-215-1007
Mailing address:
  • Phone: 469-341-7800
  • Fax: 469-314-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MUNIR AHMAD
Title or Position: OWNER
Credential: MD
Phone: 972-375-1846