MEDICARE: PCDI HEALTHCARE AND CONSULTANTS OF TEXAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	251E00000X	Home Health Agency	32016909494	TX

General Provider Information

NPI Number	:	1043454614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PCDI HEALTHCARE AND CONSULTANTS OF TEXAS

Provider Business Mailing Address
First Line	:	638 CEDARCLIFF DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-4208
Country	:	US
Telephone Number	:	972-955-1911
Fax Number	:	214-467-4315

Provider Business Practice Location Address
First Line	:	610 UPTOWN BLVD STE 2000
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-3528
Country	:	US
Telephone Number	:	469-445-9866
Fax Number	:	972-863-3091

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATOR
Name	:	DR. ANTHONY D WALLACE
Credential	:	DRPH
Telephone Number	:	469-445-9866

Provider Enumeration Date	:	04/28/2009
Last Update Date	:	06/24/2019

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