=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568997500
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AD PRECISION HEALTH CLINIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2017
-----------------------------------------------------
Last Update Date | 04/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2810 E. TRINITY MILLS ROAD SUITE 130
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-417-1936
-----------------------------------------------------
Fax | 972-692-5694
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2810 E TRINITY MILLS RD SUITE 130
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-2545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-417-1936
-----------------------------------------------------
Fax | 972-692-5694
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. AARON EUBANKS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 972-417-1936
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | R0556
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------