Healthcare Provider Details

I. General information

NPI: 1760876296
Provider Name (Legal Business Name): MEDSPRING OF TEXAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 N CENTRAL EXPY
DALLAS TX
75205-4022
US

IV. Provider business mailing address

2901 VIA FORTUNA
AUSTIN TX
78746-7565
US

V. Phone/Fax

Practice location:
  • Phone: 469-804-9280
  • 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