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General NPI Number Information
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NPI Number | 1124342811
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Entity Type | Organization
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Legal Business Name | MTS HEALTH SERVICES LLC
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 7777 FOREST LN
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City | DALLAS
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State | TX
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Zip | 75230-2505
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Country | US
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Telephone | 972-566-8430
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Fax | 214-369-9291
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Provider Business Mailing Address
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Address Line | 6611 HILLCREST AVE # 435
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City | DALLAS
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State | TX
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Zip | 75205-1301
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Country | US
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Telephone | 214-526-5247
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Fax | 214-369-9291
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CONNIE CASAD MALONE
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Credential | M.D.
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Telephone | 214-526-5247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | G3219
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License Number State | TX
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