Healthcare Provider Details

I. General information

NPI: 1114239076
Provider Name (Legal Business Name): TURTLE CREEK MEDICAL MANAGEMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 TURTLE CREEK BLVD SUITE 1101
DALLAS TX
75219-5405
US

IV. Provider business mailing address

3131 TURTLE CREEK BLVD SUITE 1101
DALLAS TX
75219-5405
US

V. Phone/Fax

Practice location:
  • Phone: 214-526-1133
  • Fax: 214-526-1136
Mailing address:
  • Phone: 214-526-1133
  • Fax: 214-526-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number261QP3300X
License Number StateTX

VIII. Authorized Official

Name: ANTHONY JAMES POLK
Title or Position: PRESIDENT
Credential:
Phone: 214-526-1133