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General NPI Number Information
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NPI Number | 1922494293
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Entity Type | Organization
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Legal Business Name | RED BIRD URGENT CARE CLINIC, P.A.
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 4323 S HAMPTON RD
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City | DALLAS
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State | TX
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Zip | 75232-1058
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Country | US
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Telephone | 214-330-7777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6539
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City | FORT WORTH
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State | TX
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Zip | 76115-0539
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LAZUANDA GLEN
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Credential |
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Telephone | 817-744-7524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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