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General NPI Number Information
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NPI Number | 1861577579
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Entity Type | Organization
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Legal Business Name | EXTENDED MEDICAL MANAGEMENT SERVICES, INC.
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 13140 COIT RD SUITE 212
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City | DALLAS
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State | TX
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Zip | 75240-5755
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Country | US
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Telephone | 469-330-2444
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Fax | 469-330-2396
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Provider Business Mailing Address
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Address Line | 13140 COIT RD SUITE 212
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City | DALLAS
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State | TX
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Zip | 75240-5755
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Country | US
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Telephone | 469-330-2444
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Fax | 469-330-2396
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DERRICK L BOWMAN SR.
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Credential |
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Telephone | 469-330-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 506447
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | M2309
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License Number State | TX
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