Healthcare Provider Details

I. General information

NPI: 1912396029
Provider Name (Legal Business Name): QUINLAN MEDICAL HOME VISITS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8414 FLOWER MEADOW DR
DALLAS TX
75243-7424
US

IV. Provider business mailing address

8414 FLOWER MEADOW DR
DALLAS TX
75243-7424
US

V. Phone/Fax

Practice location:
  • Phone: 214-324-9400
  • Fax: 214-324-9402
Mailing address:
  • Phone: 214-324-9400
  • Fax: 214-324-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberK7022
License Number StateTX

VIII. Authorized Official

Name: KENNETH DORITY
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 214-324-9400