Healthcare Provider Details

I. General information

NPI: 1114391653
Provider Name (Legal Business Name): MEDSPRING OF TEXAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 LEMMON AVE
DALLAS TX
75219-2145
US

IV. Provider business mailing address

3711 S MOPAC EXPWY BLDG 2 STE 400
AUSTIN TX
78746-8014
US

V. Phone/Fax

Practice location:
  • Phone: 469-672-4238
  • Fax: 512-485-7393
Mailing address:
  • Phone: 512-765-9003
  • Fax: 512-410-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL KADERLI
Title or Position: CONTRACTING MANAGER
Credential:
Phone: 512-765-9003