Organization
KILLEEN NEUROLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAMSUDDIN KHWAJA M.D. (OWNER)
(254) 554-3377
Entity
Organization
Contact information
Practice address
2105 S CLEAR CREEK RD, KILLEEN, TX 76549-4110
(254) 554-3377
(254) 554-3389
Mailing address
PO BOX 938, KILLEEN, TX 76540-0938
(254) 634-6999
(254) 200-4090
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L9285
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003MS
BLUE CROSS BLUE SHIELD
TX
05
—
173994801
—
TX
01
—
DC5542
MEDICARE RAILRAOD
TX
Enumeration date
06/25/2006
Last updated
06/11/2010
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