Provider Demographics
NPI:1235306820
Name:T S HOSSAIN MD PA
Entity type:Organization
Organization Name:T S HOSSAIN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAWHID
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:HOSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-823-3394
Mailing Address - Street 1:301 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE #215
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-823-3394
Mailing Address - Fax:904-823-8557
Practice Address - Street 1:301 HEALTH PARK BLVD
Practice Address - Street 2:SUITE #215
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-823-3394
Practice Address - Fax:904-823-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4293890001Medicare NSC