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General NPI Number Information
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NPI Number | 1144262296
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Entity Type | Organization
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Legal Business Name | ACCUCARE FAMILY MEDICAL CENTER P.A.
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 1650 W COLLEGE ST
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City | GRAPEVINE
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State | TX
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Zip | 76051-3565
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Country | US
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Telephone | 972-816-0459
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Fax |
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Provider Business Mailing Address
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Address Line | 709 WEST RUSK STREET, SUITE B, #867
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City | ROCKWALL
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State | TX
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Zip | 75087
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Country | US
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Telephone | 972-786-0140
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Fax | 972-786-0142
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MAXINE A THERIOT
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Credential | MD
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Telephone | 972-816-0459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J9578
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | J9578
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License Number State | TX
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