Healthcare Provider Details

I. General information

NPI: 1871019828
Provider Name (Legal Business Name): PARIS LAKES HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 41ST ST SE STE 102
PARIS TX
75462-8209
US

IV. Provider business mailing address

9475 BRIAR VILLAGE PT STE 220
COLORADO SPRINGS CO
80920-7908
US

V. Phone/Fax

Practice location:
  • Phone: 903-739-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA WILLIAMS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 903-609-1065