Internal Medicine Associates of South Dallas PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

L3488 Issued in TX

Legal business name

INTERNAL MEDICINE ASSOCIATES OF SOUTH DALLAS PA

Practice address

4305 W Wheatland Rd
Suite Number 101
Dallas, TX 75237-3303

Phone

(214) 697-7985

Fax

(972) 708-9498

NPI assigned

Oct 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ashwani Dayal Srivastava, MD

Title

President

Phone

(214) 697-7985

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414454400000",
    "number": "1205023397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4305 W WHEATLAND RD",
            "address_2": "SUITE NUMBER 101",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752373303",
            "telephone_number": "214-697-7985",
            "fax_number": "972-708-9498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 W WHEATLAND RD",
            "address_2": "SUITE NUMBER 101",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752373303",
            "telephone_number": "214-697-7985",
            "fax_number": "972-708-9498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES OF SOUTH DALLAS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2014-10-28",
        "status": "A",
        "authorized_official_last_name": "SRIVASTAVA",
        "authorized_official_first_name": "ASHWANI",
        "authorized_official_middle_name": "DAYAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-697-7985",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "L3488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150972102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0047QW",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1467507038",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191673601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.