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General NPI Number Information
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NPI Number | 1003354572
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS EXCEL PHYSICIANS II, PLLC
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 730 ADAMS DR
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City | WEATHERFORD
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State | TX
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Zip | 76086-6266
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Country | US
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Telephone | 817-594-0911
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6525
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City | CORPUS CHRISTI
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State | TX
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Zip | 78466-6525
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Country | US
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Telephone | 361-884-2904
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Fax | 361-884-1912
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MRS. LISA SMITH
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Credential |
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Telephone | 361-884-2904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | 160167
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License Number State | TX
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