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General NPI Number Information
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NPI Number | 1639464324
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Entity Type | Organization
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Legal Business Name | BUFFALO VISTA URGENT FAMILY CARE, PLLC
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 1045 E RAILROAD
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City | BUFFALO
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State | TX
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Zip | 75831
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Country | US
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Telephone | 903-322-9309
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Fax | 903-322-9066
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Provider Business Mailing Address
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Address Line | 2033 W MCDERMOTT DR STE 320-215
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City | ALLEN
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State | TX
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Zip | 75013-4694
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Country | US
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Telephone | 903-322-9309
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Fax | 903-322-9066
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROLAND DAVID IBONI
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Credential | D.O
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Telephone | 214-454-2466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | L7424
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License Number State | TX
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