Healthcare Provider Details

I. General information

NPI: 1306251541
Provider Name (Legal Business Name): SELECTIVE MEDICAL STAFFING OF TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 MATLOCK RD SUITE 207
ARLINGTON TX
76015-2917
US

IV. Provider business mailing address

3330 MATLOCK RD SUITE 207
ARLINGTON TX
76015-2917
US

V. Phone/Fax

Practice location:
  • Phone: 903-647-4512
  • Fax: 877-753-9230
Mailing address:
  • Phone: 903-647-4512
  • Fax: 877-753-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. MARISA GLADEN
Title or Position: CEO
Credential:
Phone: 903-647-4512