Healthcare Provider Details

I. General information

NPI: 1174731517
Provider Name (Legal Business Name): CORPORATE-INDUSTRY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 W AIRPORT FWY SUITE 305
IRVING TX
75062-5832
US

IV. Provider business mailing address

4425 W AIRPORT FWY SUITE 305
IRVING TX
75062-5832
US

V. Phone/Fax

Practice location:
  • Phone: 972-570-8200
  • Fax: 972-570-8933
Mailing address:
  • Phone: 972-570-8200
  • Fax: 972-570-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE F HEATH
Title or Position: CEO
Credential: CLU
Phone: 972-570-8200