Healthcare Provider Details

I. General information

NPI: 1407968316
Provider Name (Legal Business Name): MEDICAL CLINIC OF NORTH TEXAS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 SCRIPTURE ST SUITE 200
DENTON TX
76201-2313
US

IV. Provider business mailing address

9003 AIRPORT FWY SUITE 300
NORTH RICHLAND HILLS TX
76180-7770
US

V. Phone/Fax

Practice location:
  • Phone: 940-591-6600
  • Fax: 940-591-6600
Mailing address:
  • Phone: 817-514-5200
  • Fax: 817-514-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberM2590
License Number StateTX

VIII. Authorized Official

Name: MS. PAMELA KINNEY COUTANT
Title or Position: ADMINISTRATIVE ASSISTANT
Credential: M.B.A.
Phone: 817-514-5258