| Shabnam Qasim Mdpa | |
|
4819 River Oaks Blvd Fort Worth TX 76114 | |
| (817) 626-9744 | |
| (817) 626-9962 |
| Full Name | Shabnam Qasim Mdpa |
|---|---|
| Speciality | Internal Medicine |
| Location | 4819 River Oaks Blvd, Fort Worth, Texas |
| Authorized Official Name and Position | Shabnam K Qasim (PRESIDENT) |
| Authorized Official Contact | 8176269744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shabnam Qasim Mdpa 4819 River Oaks Blvd Fort Worth TX 76114 Ph: (817) 626-9744 | Shabnam Qasim Mdpa 4819 River Oaks Blvd Fort Worth TX 76114 Ph: (817) 626-9744 |
| NPI Number | 1396792602 |
|---|---|
| Provider Enumeration Date | 05/30/2006 |
| Last Update Date | 11/13/2013 |
| Medicare PECOS PAC ID | 5698902120 |
|---|---|
| Medicare Enrollment ID | O20131209000637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396792602 | NPI | - | NPPES |
| 1634057 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | K9397 (Texas) | Primary |
| Provider Name | Shabnam K Qasim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043243512 PECOS PAC ID: 2668632316 Enrollment ID: I20120404000548 |
| Provider Name | Sarah Carrillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487343349 PECOS PAC ID: 5496197212 Enrollment ID: I20240524001969 |
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