=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245726108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PDS TURNKEY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2018
-----------------------------------------------------
Last Update Date | 07/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18320 MICHAELANGELO DR APT SUITE
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75287-3334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-576-0640
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18320 MICHAELANGELO DR APT SUITE
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75287-3334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-576-0640
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DENISE NOLAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-388-4777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0001X
-----------------------------------------------------
Taxonomy Name | Clinical Cardiac Electrophysiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------