Healthcare Provider Details

I. General information

NPI: 1497941710
Provider Name (Legal Business Name): EXTRACARE PALLIATIVE CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16721 DECKER CREEK DR
MANOR TX
78653-5012
US

IV. Provider business mailing address

16721 DECKER CREEK DR
MANOR TX
78653-5012
US

V. Phone/Fax

Practice location:
  • Phone: 479-366-4882
  • Fax: 866-838-7772
Mailing address:
  • Phone: 479-366-4882
  • Fax: 866-838-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberH6493
License Number StateTX

VIII. Authorized Official

Name: DR. DENNIS SAMUEL PACL
Title or Position: PRESIDENT
Credential: MD
Phone: 479-366-4882