=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417615006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANS OAKLEY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2021
-----------------------------------------------------
Last Update Date | 12/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 738 W CENTERVILLE RD
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75041-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-566-1232
-----------------------------------------------------
Fax | 817-984-5434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1005 S CROWLEY RD STE P
-----------------------------------------------------
City | CROWLEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76036-3698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-566-1232
-----------------------------------------------------
Fax | 817-984-5434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING ADMINISTRATOR
-----------------------------------------------------
Name | JORDAN TYLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-566-1232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------