=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740556422
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLOAN MEDICAL, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2012
-----------------------------------------------------
Last Update Date | 04/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5801 A VIRGINIA PKWY STE 200
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-4970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-548-1650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5801 A VIRGINIA PKWY STE 200
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-5084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-548-1650
-----------------------------------------------------
Fax | 972-548-1621
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | SAMANTHA ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-548-1650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 9062
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------