Healthcare Provider Details

I. General information

NPI: 1891741922
Provider Name (Legal Business Name): PATIENT PLACE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOSPITAL DR STE 140
CORSICANA TX
75110
US

IV. Provider business mailing address

14850 MONTFORT DR STE 181
DALLAS TX
75254-1450
US

V. Phone/Fax

Practice location:
  • Phone: 903-201-6405
  • Fax: 903-257-3800
Mailing address:
  • Phone: 214-715-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES W. BLAMER
Title or Position: COO
Credential:
Phone: 214-333-7333