Active NPI
Mamudu Balima Issah, MT
- Clinical Medical Laboratory
- Euless, TX
National Provider Identifier
1104095132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- License
- 51513
- Practice address
- 1307 Cedar Ridge Ter
Euless, TX 76039-2807 - Phone
- (682) 465-7542
- NPI assigned
- Feb 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 51513 | IL | Primary |
Addresses
Primary practice location
1307 Cedar Ridge Ter
Euless, TX 76039-2807
Mailing address
PO Box 192
Euless, TX 76039-0192
Phone (682) 465-7542
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51513 | IL | MD | Clinical Medical Laboratory |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203811200000",
"number": "1104095132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 192",
"city": "EULESS",
"state": "TX",
"postal_code": "760390192",
"telephone_number": "682-465-7542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1307 CEDAR RIDGE TER",
"city": "EULESS",
"state": "TX",
"postal_code": "760392807",
"telephone_number": "682-465-7542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISSAH",
"first_name": "MAMUDU",
"middle_name": "BALIMA",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-24",
"last_updated": "2008-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "IL",
"license": "51513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Euless, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.