=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164478343
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROMPT CARE INTERNAL MEDICINE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 03/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 MEDICAL PKWY SUITE 209
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-620-8100
-----------------------------------------------------
Fax | 972-620-8106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 MEDICAL PKWY SUITE 209
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-620-8100
-----------------------------------------------------
Fax | 972-620-8106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BASIL A YOUNIS
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 972-620-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | K 9942
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------