MEDICARE: OPEN ARMS HEALTHCARE OF TEXAS INC.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1467921346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN ARMS HEALTHCARE OF TEXAS INC.

Provider Business Mailing Address
First Line	:	8150 SPRINGWOOD DR # 150B
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-5810
Country	:	US
Telephone Number	:	214-396-7397
Fax Number	:	214-396-7397

Provider Business Practice Location Address
First Line	:	2304 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1638
Country	:	US
Telephone Number	:	214-337-7200
Fax Number	:	214-337-7206

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ANDREA CARRILLO
Credential	:
Telephone Number	:	817-831-6500

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	01/26/2022

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