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General NPI Number Information
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NPI Number | 1982214375
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Entity Type | Organization
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Legal Business Name | HIPPOMED WELLNESS CLINICS LIMITED COMPANY
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 5930 LBJ FWY STE 380
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City | DALLAS
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State | TX
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Zip | 75240-6370
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Country | US
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Telephone | 972-803-6008
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Fax | 469-460-6558
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Provider Business Mailing Address
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Address Line | 5930 LBJ FWY STE 380
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City | DALLAS
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State | TX
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Zip | 75240-6370
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Country | US
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Telephone | 972-803-6008
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Fax | 469-460-6558
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. CHRIS BROWN
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Credential |
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Telephone | 253-709-6790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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