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General NPI Number Information
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NPI Number | 1407968316
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Entity Type | Organization
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Legal Business Name | MEDICAL CLINIC OF NORTH TEXAS, P.A.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2501 SCRIPTURE ST SUITE 200
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City | DENTON
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State | TX
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Zip | 76201-2313
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Country | US
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Telephone | 940-591-6600
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Fax | 940-591-6600
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Provider Business Mailing Address
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Address Line | 9003 AIRPORT FWY SUITE 300
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-7770
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Country | US
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Telephone | 817-514-5200
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Fax | 817-514-5210
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. PAMELA KINNEY COUTANT
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Credential | M.B.A.
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Telephone | 817-514-5258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | M2590
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License Number State | TX
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