Healthcare Provider Details

I. General information

NPI: 1023488707
Provider Name (Legal Business Name): BARKER BARIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 N CENTRAL EXPY SUITE 305
DALLAS TX
75243-3755
US

IV. Provider business mailing address

12222 N CENTRAL EXPY SUITE 305
DALLAS TX
75243-3755
US

V. Phone/Fax

Practice location:
  • Phone: 972-270-4800
  • Fax: 214-367-1153
Mailing address:
  • Phone: 972-270-4800
  • Fax: 214-367-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberJ1859
License Number StateTX

VIII. Authorized Official

Name: MS. AUDREY N NIEMIETZ
Title or Position: BILLING MANAGER
Credential:
Phone: 830-491-7090