Imdad Long Term Care, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2000160629 Issued in MO

Legal business name

IMDAD LONG TERM CARE, LLC

Practice address

18 Lochhaven LN
Ballwin, MO 63021-8020

Phone

(636) 527-9595

Fax

(636) 527-9595

NPI assigned

Nov 21, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Riffat Y Imdad, M.D.

Title

President

Phone

(314) 651-6129

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479686400000",
    "number": "1891238077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 W 4TH ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981378",
            "telephone_number": "618-939-1193",
            "fax_number": "618-939-7539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 LOCHHAVEN LN",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630218020",
            "telephone_number": "636-527-9595",
            "fax_number": "636-527-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMDAD LONG TERM CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-21",
        "last_updated": "2016-11-21",
        "status": "A",
        "authorized_official_last_name": "IMDAD",
        "authorized_official_first_name": "RIFFAT",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-651-6129",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2000160629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Fienup Hooper, M.S., CCC-SLP
• Mark T Houston, MD
• Salma Hussain, OTD
• Tiffany Ice
• Illuminate ABA
• Shanna M Ingram, FNP-C
• Elizabeth Irwin, LPC
• Annette Israel
• Rasha Issou
• Viktoriya V. Ivantsova, PMHNP-BC

• Internal Medicine Physician in Ballwin, MO
• Providers in Ballwin, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; 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.