=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972062586
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APEX MEDICAL GROUP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2019
-----------------------------------------------------
Last Update Date | 05/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 290 S PRESTON RD STE 240
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-9835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-378-0383
-----------------------------------------------------
Fax | 972-403-3434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 DALLAS PKWY STE 150
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-378-0383
-----------------------------------------------------
Fax | 972-403-3434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JADE MALAY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 214-734-3585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------