Healthcare Provider Details
I. General information
NPI: 1194198101
Provider Name (Legal Business Name): SUREPOINT EMERGENCY PHYSICIANS DENTON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/12/2015
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2426 LILLIAN MILLER PKWY
DENTON TX
76205-2908
US
IV. Provider business mailing address
2300 MATLOCK RD STE 35
MANSFIELD TX
76063-5018
US
V. Phone/Fax
- Phone: 940-218-6712
- Fax: 940-218-6715
- Phone: 469-830-8200
- Fax: 469-830-8201
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 174400000X |
| Taxonomy | Specialist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MICHELLE
NEWSOM
Title or Position: PRESIDENT
Credential:
Phone: 469-830-8200