Healthcare Provider Details

I. General information

NPI: 1427503705
Provider Name (Legal Business Name): HLM MEDICAL MANAGEMENT FIRM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 VICTORY PARK LN SUITE 1034
DALLAS TX
75219-7610
US

IV. Provider business mailing address

2408 VICTORY PARK LN SUITE 1034
DALLAS TX
75219-7610
US

V. Phone/Fax

Practice location:
  • Phone: 817-995-1888
  • Fax: 888-413-9768
Mailing address:
  • Phone: 817-995-1888
  • Fax: 888-413-9768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04265
License Number StateTX

VIII. Authorized Official

Name: MISS HEID LYNN MEDCALF
Title or Position: OWNER
Credential: PA-C
Phone: 817-995-1888