MEDICARE: MEDTEX OF DALLAS

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	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1740565084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTEX OF DALLAS

Provider Business Mailing Address
First Line	:	PO BOX 1390
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-7390
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6363 FOREST PARK RD
Second Line	:	SUITE 810
City	:	DALLAS
State	:	TX
Zip	:	75235-5479
Country	:	US
Telephone Number	:	214-631-3139
Fax Number	:	214-350-1155

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MS. DONNA BUSBY
Credential	:
Telephone Number	:	708-539-7740

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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Directions to “MEDTEX OF DALLAS ” Practice Location

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