Healthcare Provider Details

I. General information

NPI: 1629580881
Provider Name (Legal Business Name): MEDICAL SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ASPEN ST
LANCASTER TX
75134-3204
US

IV. Provider business mailing address

102 ASPEN ST
LANCASTER TX
75134-3204
US

V. Phone/Fax

Practice location:
  • Phone: 972-740-7413
  • Fax: 469-750-7317
Mailing address:
  • Phone: 972-740-7413
  • Fax: 469-750-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE YVETTE ROGERS
Title or Position: DIEWCTOR
Credential:
Phone: 972-740-7413