=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932538147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITE ROCK ADULTMEDICINE ASSOC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2013
-----------------------------------------------------
Last Update Date | 11/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10405 E. NORTHWEST HYW. #100
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-4610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-321-6485
-----------------------------------------------------
Fax | 214-324-3187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10405 E. NORTHWEST HYW #100
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-321-6485
-----------------------------------------------------
Fax | 214-324-3187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. KELLEY SUZANNE FELIX
-----------------------------------------------------
Credential | MT, CMOM
-----------------------------------------------------
Telephone | 214-321-6485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 806914
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------