=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053936856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABSOLUTE PRIMARY CARE HOUSE CALLS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2020
-----------------------------------------------------
Last Update Date | 08/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1925 E BELT LINE RD STE 208
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-5826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-666-9200
-----------------------------------------------------
Fax | 469-900-8090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1925 E BELT LINE RD STE 208
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-5826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-666-9200
-----------------------------------------------------
Fax | 469-900-8090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ADMINISTRATIVE OFFICER
-----------------------------------------------------
Name | LOTTIE M. EVERETT
-----------------------------------------------------
Credential | MSN APRN FNP-C
-----------------------------------------------------
Telephone | 972-666-9200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------