Provider Demographics
NPI:1174873087
Name:MAMOONA SHAIKH-AHMAD, MD, PA
Entity type:Organization
Organization Name:MAMOONA SHAIKH-AHMAD, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-761-0329
Mailing Address - Street 1:PO BOX 64412
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-4412
Mailing Address - Country:US
Mailing Address - Phone:806-761-0334
Mailing Address - Fax:806-785-0872
Practice Address - Street 1:5219 CITY BANK PKWY
Practice Address - Street 2:SUITE 35
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3544
Practice Address - Country:US
Practice Address - Phone:806-761-0334
Practice Address - Fax:806-785-0872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0851207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty