Healthcare Provider Details

I. General information

NPI: 1609053412
Provider Name (Legal Business Name): NEWLANDS INPATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 EAST BROAD ST.
MANSFIELD TX
76063
US

IV. Provider business mailing address

1717 MAIN ST. SUITE 5200
DALLAS TX
75201
US

V. Phone/Fax

Practice location:
  • Phone: 682-622-2000
  • Fax:
Mailing address:
  • Phone: 214-712-2000
  • Fax: 214-712-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM C JERNBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 214-712-2000