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General NPI Number Information
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NPI Number | 1942845565
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Entity Type | Organization
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Legal Business Name | PREFERRED CARDIO CHECKUP MANAGEMENT LLC
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 211 BENT CREEK DR
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City | WAXAHACHIE
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State | TX
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Zip | 75165-6353
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Country | US
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Telephone | 972-281-7328
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Fax |
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Provider Business Mailing Address
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Address Line | 211 BENT CREEK DR
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City | WAXAHACHIE
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State | TX
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Zip | 75165-6353
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Country | US
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Telephone | 972-281-7328
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. MARY BENNER
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Credential |
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Telephone | 972-281-7328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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