=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841807526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TALO MEDICAL MANAGEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2020
-----------------------------------------------------
Last Update Date | 09/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4190 FM 2933
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-0352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-489-6083
-----------------------------------------------------
Fax | 214-975-2102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4190 FM 2933
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-0352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-489-6083
-----------------------------------------------------
Fax | 214-975-2102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. ROBERT CLIFTON RANKINS III
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 972-489-6083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------