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General NPI Number Information
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NPI Number | 1861972556
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Entity Type | Organization
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Legal Business Name | RED DIAMOND MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 2700 TIBBETS DR # 301
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City | BEDFORD
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State | TX
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Zip | 76022
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Country | US
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Telephone | 817-779-4514
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Fax | 817-779-4608
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Provider Business Mailing Address
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Address Line | 2700 TIBBETS DR # 301
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City | BEDFORD
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State | TX
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Zip | 76022-5928
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Country | US
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Telephone | 817-779-4514
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Fax | 817-779-4608
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TIFFANIE SAMUELSON
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Credential |
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Telephone | 817-778-9441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious 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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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