Healthcare Provider Details

I. General information

NPI: 1972936102
Provider Name (Legal Business Name): 9397 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 HAWKINS VIEW DR
FORT WORTH TX
76132-3921
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 Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MELANIE GROSS
Title or Position: VP OF REVENUE CYCLE SOLUTIONS
Credential:
Phone: 214-615-5168