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General NPI Number Information
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NPI Number | 1134326739
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Entity Type | Organization
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Legal Business Name | KILLEEN INJURY CLINIC, INC.
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 100 E CENTRAL TEXAS EXPY SUITE 100
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City | KILLEEN
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State | TX
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Zip | 76541-8525
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Country | US
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Telephone | 254-501-3555
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Fax | 254-501-3554
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Provider Business Mailing Address
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Address Line | 5931 DESCO DRIVE
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City | DALLAS
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State | TX
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Zip | 75225
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Country | US
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Telephone | 214-692-6666
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Fax | 214-692-6670
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Authorized Official
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Title or Position | CEO
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Name | MR. NAT MANGUM
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Credential |
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Telephone | 469-688-6628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14136
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | J1957
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1030278
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License Number State | TX
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