MEDICARE: ZIMA MEDICAL GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003288879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZIMA MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	12030 BANDERA RD
Second Line	:	STE. 128
City	:	HELOTES
State	:	TX
Zip	:	78023-4735
Country	:	US
Telephone Number	:	210-685-8111
Fax Number	:	210-569-6581

Provider Business Practice Location Address
First Line	:	12030 BANDERA RD
Second Line	:	STE. 128
City	:	HELOTES
State	:	TX
Zip	:	78023-4735
Country	:	US
Telephone Number	:	210-685-8111
Fax Number	:	210-569-6581

Authorized Official
Title or Position	:	OWNER
Name	:	OBINNA HENRY OZIBGO
Credential	:	MD
Telephone Number	:	210-241-7562

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	03/10/2017

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