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General NPI Number Information
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NPI Number | 1821252404
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Entity Type | Organization
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Legal Business Name | MUTUAL HEALTHCARE SYSTEMS INC
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 1220 INDIAN RUN DR SUITE 621
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City | CARROLLTON
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State | TX
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Zip | 75010-1194
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Country | US
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Telephone | 469-877-8124
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Fax | 214-483-5809
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Provider Business Mailing Address
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Address Line | 1220 INDIAN RUN DR SUITE 621
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City | CARROLLTON
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State | TX
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Zip | 75010-1194
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Country | US
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Telephone | 469-877-8124
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Fax | 214-483-5809
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. FRANK E MBAH JR.
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Credential |
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Telephone | 214-731-6988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 011544
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License Number State | TX
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