MEDICARE: COMPREHENSIVE INJURY TREATMENT SERVICES 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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	P1691	TX
2	208D00000X	General Practice Physician	P1691	TX

General Provider Information

NPI Number	:	1811325954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE INJURY TREATMENT SERVICES PLLC

Provider Business Mailing Address
First Line	:	1602 W AVENUE A
Second Line	:	STE B
City	:	TEMPLE
State	:	TX
Zip	:	76504-4080
Country	:	US
Telephone Number	:	254-778-6474
Fax Number	:	254-778-6491

Provider Business Practice Location Address
First Line	:	1602 W AVENUE A
Second Line	:	STE B
City	:	TEMPLE
State	:	TX
Zip	:	76504-4080
Country	:	US
Telephone Number	:	254-778-6474
Fax Number	:	254-778-6491

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. HAMEED ALI
Credential	:	MD
Telephone Number	:	254-899-2225

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	11/17/2015

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