MEDICARE: TURTLE CREEK MEDICAL MANAGEMENT CORP

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	261QP3300X	Pain Clinic/Center	261QP3300X	TX

General Provider Information

NPI Number	:	1114239076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TURTLE CREEK MEDICAL MANAGEMENT CORP

Provider Business Mailing Address
First Line	:	3131 TURTLE CREEK BLVD
Second Line	:	SUITE 1101
City	:	DALLAS
State	:	TX
Zip	:	75219-5405
Country	:	US
Telephone Number	:	214-526-1133
Fax Number	:	214-526-1136

Provider Business Practice Location Address
First Line	:	3131 TURTLE CREEK BLVD
Second Line	:	SUITE 1101
City	:	DALLAS
State	:	TX
Zip	:	75219-5405
Country	:	US
Telephone Number	:	214-526-1133
Fax Number	:	214-526-1136

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY JAMES POLK
Credential	:
Telephone Number	:	214-526-1133

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	02/04/2014

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