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General NPI Number Information
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NPI Number | 1124134176
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Entity Type | Organization
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Legal Business Name | HEALTHKWIK TEXAS INC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 3434 W ILLINOIS AVE
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City | DALLAS
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State | TX
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Zip | 75211-8796
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Country | US
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Telephone | 214-333-9600
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Fax | 214-333-9602
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Provider Business Mailing Address
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Address Line | PO BOX 671621
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City | DALLAS
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State | TX
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Zip | 75267-1621
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Country | US
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Telephone | 972-580-7700
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Fax | 972-580-7715
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | JODI KRUSELY
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Credential |
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Telephone | 847-838-3832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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