Healthcare Provider Details

I. General information

NPI: 1033484431
Provider Name (Legal Business Name): CENTRAL MEDICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 N CENTRAL EXPY SUITE 275
DALLAS TX
75231-2161
US

IV. Provider business mailing address

PO BOX 3837
CAROL STREAM IL
60132-3837
US

V. Phone/Fax

Practice location:
  • Phone: 214-615-5168
  • Fax: 888-526-9542
Mailing address:
  • Phone: 214-615-5168
  • Fax: 888-526-9542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. DOUGLAS JOHNSON
Title or Position: OWNER
Credential: PA
Phone: 214-615-5168