Healthcare Provider Details

I. General information

NPI: 1003354572
Provider Name (Legal Business Name): NORTH TEXAS EXCEL PHYSICIANS II, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 ADAMS DR
WEATHERFORD TX
76086-6266
US

IV. Provider business mailing address

PO BOX 6525
CORPUS CHRISTI TX
78466-6525
US

V. Phone/Fax

Practice location:
  • Phone: 817-594-0911
  • Fax:
Mailing address:
  • Phone: 361-884-2904
  • Fax: 361-884-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number160167
License Number StateTX

VIII. Authorized Official

Name: MRS. LISA SMITH
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 361-884-2904