Healthcare Provider Details

I. General information

NPI: 1841793312
Provider Name (Legal Business Name): HRA IQ-TX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 JOHN CT
FLOWER MOUND TX
75028-1144
US

IV. Provider business mailing address

4220 JOHN CT
FLOWER MOUND TX
75028-1144
US

V. Phone/Fax

Practice location:
  • Phone: 214-554-3329
  • Fax:
Mailing address:
  • Phone: 214-554-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS J CINI
Title or Position: COO
Credential:
Phone: 214-554-3329