Healthcare Provider Details

I. General information

NPI: 1093006389
Provider Name (Legal Business Name): AMERITEX HOUSECALLS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 E NORTHWEST HWY SUITE 251
DALLAS TX
75238-4608
US

IV. Provider business mailing address

10440 E NORTHWEST HWY SUITE 251
DALLAS TX
75238-4608
US

V. Phone/Fax

Practice location:
  • Phone: 214-272-8192
  • Fax: 214-484-4839
Mailing address:
  • Phone: 214-272-8192
  • Fax: 214-484-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1513
License Number StateTX

VIII. Authorized Official

Name: DR. SHANNON LEE GALLENTINE
Title or Position: DIRECTOR
Credential: D.P.M.
Phone: 214-949-0130