=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235509571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHMAD AMIRDASH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2015
-----------------------------------------------------
Last Update Date | 04/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2646 S LOOP W STE 330
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-2773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-269-6250
-----------------------------------------------------
Fax | 832-604-4285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2646 S LOOP W STE 330
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-2773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-888-4407
-----------------------------------------------------
Fax | 832-604-4285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 794504
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | AP129602
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------