=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518205558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS OBS-1 MEDICAL SERVICES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2013
-----------------------------------------------------
Last Update Date | 01/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5252 W UNIVERSITY DR
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-7822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-764-5000
-----------------------------------------------------
Fax | 214-712-2444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13737 NOEL RD STE 1600
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-1374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-712-2074
-----------------------------------------------------
Fax | 214-712-2444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | ADAM CORLEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-712-2074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------