Healthcare Provider Details

I. General information

NPI: 1942704283
Provider Name (Legal Business Name): ZOOM INITIATIVE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12959 JUPITER RD. SUITE 140
DALLAS TX
75238
US

IV. Provider business mailing address

12959 JUPITER RD. SUITE 140
DALLAS TX
75238
US

V. Phone/Fax

Practice location:
  • Phone: 214-221-0132
  • Fax: 214-221-0242
Mailing address:
  • Phone: 214-221-0132
  • Fax: 214-221-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GEORGE NEBE
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-221-0132