Healthcare Provider Details

I. General information

NPI: 1538531769
Provider Name (Legal Business Name): NEW GEN OF HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 SOUTHWESTERN BLVD 623
DALLAS TX
75206-2675
US

IV. Provider business mailing address

8609 SOUTHWESTERN BLVD 623
DALLAS TX
75206-2675
US

V. Phone/Fax

Practice location:
  • Phone: 318-655-3328
  • Fax:
Mailing address:
  • Phone: 318-655-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberQ2690
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberQ2690
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberQ2690
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberQ2690
License Number StateTX

VIII. Authorized Official

Name: DR. KENNY NEWGENE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 318-655-3328