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General NPI Number Information
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NPI Number | 1740565084
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Entity Type | Organization
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Legal Business Name | MEDTEX OF DALLAS
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 6363 FOREST PARK RD SUITE 810
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City | DALLAS
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State | TX
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Zip | 75235-5479
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Country | US
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Telephone | 214-631-3139
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Fax | 214-350-1155
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Provider Business Mailing Address
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Address Line | PO BOX 1390
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City | FRANKFORT
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State | IL
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Zip | 60423-7390
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. DONNA BUSBY
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Credential |
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Telephone | 708-539-7740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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