Healthcare Provider Details

I. General information

NPI: 1922494293
Provider Name (Legal Business Name): RED BIRD URGENT CARE CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 S HAMPTON RD
DALLAS TX
75232-1058
US

IV. Provider business mailing address

PO BOX 6539
FORT WORTH TX
76115-0539
US

V. Phone/Fax

Practice location:
  • Phone: 214-330-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAZUANDA GLEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 817-744-7524