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General NPI Number Information
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NPI Number | 1851717508
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Entity Type | Organization
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Legal Business Name | CRITICAL CARE SPECIALISTS OF NORTH TEXAS, PLLC
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 03/05/2014
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Provider Practice Location Address
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Address Line | 1600 11TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4300
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Country | US
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Telephone | 940-322-4480
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Fax | 940-322-8420
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Provider Business Mailing Address
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Address Line | 1208 BROOK AVE
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City | WICHITA FALLS
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State | TX
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Zip | 76301-5602
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Country | US
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Telephone | 940-322-4480
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Fax | 940-322-8420
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAFAEL RIVERA
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Credential | MD
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Telephone | 940-357-0295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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