MEDICARE: KNOX MEDICAL GROUP PA

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	2085U0001X	Diagnostic Ultrasound Physician
2	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1659716371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOX MEDICAL GROUP PA

Provider Business Mailing Address
First Line	:	3109 KNOX ST
Second Line	:	SUITE 747
City	:	DALLAS
State	:	TX
Zip	:	75205-4029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 KNOX ST
Second Line	:	SUITE 747
City	:	DALLAS
State	:	TX
Zip	:	75205-4029
Country	:	US
Telephone Number	:	214-960-3828
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TAMMY CARPENTER
Credential	:
Telephone Number	:	214-960-3828

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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