Healthcare Provider Details

I. General information

NPI: 1164957700
Provider Name (Legal Business Name): UROLOGY CLINICS OF NORTH TEXAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 N CENTRAL EXPY STE 120
DALLAS TX
75231-0962
US

IV. Provider business mailing address

9900 N CENTRAL EXPY STE 120
DALLAS TX
75231-0962
US

V. Phone/Fax

Practice location:
  • Phone: 214-580-2265
  • Fax:
Mailing address:
  • Phone: 214-580-2265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number31363
License Number StateTX

VIII. Authorized Official

Name: SHANNEN RODRIGUEZ
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 214-692-8262