Healthcare Provider Details

I. General information

NPI: 1043753924
Provider Name (Legal Business Name): MYCAP CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 LBJ FWY SUITE 440
DALLAS TX
75240-6217
US

IV. Provider business mailing address

PO BOX 167704
IRVING TX
75016-7704
US

V. Phone/Fax

Practice location:
  • Phone: 888-551-2288
  • Fax: 888-770-6360
Mailing address:
  • Phone: 888-551-2288
  • Fax: 888-770-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberK3753
License Number StateTX

VIII. Authorized Official

Name: LANCE MILTON HOOVER
Title or Position: MEMBER
Credential:
Phone: 210-737-4406