| Do Not Use | |
|
1706 W Irving Blvd Irving TX 75061-7137 | |
| (972) 254-1474 | |
| (972) 259-3037 |
| Full Name | Do Not Use |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1706 W Irving Blvd, Irving, Texas |
| Authorized Official Name and Position | Jodi Krusely (ACCOUNT MANAGER) |
| Authorized Official Contact | 8478383832 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Do Not Use 1231 Greenway Dr Suite 120 Irving TX 75038-2533 Ph: (972) 580-7700 | Do Not Use 1706 W Irving Blvd Irving TX 75061-7137 Ph: (972) 254-1474 |
| NPI Number | 1043491467 |
|---|---|
| Provider Enumeration Date | 11/15/2007 |
| Last Update Date | 01/31/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043491467 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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