MEDICARE: RED BIRD EDUCATION PROGRAMS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	36803682	TX
2	302R00000X	Health Maintenance Organization	36803681	TX

General Provider Information

NPI Number	:	1053740472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED BIRD EDUCATION PROGRAMS PLLC

Provider Business Mailing Address
First Line	:	4549 S WESTMORELAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-1015
Country	:	US
Telephone Number	:	214-287-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4549 S WESTMORELAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-1015
Country	:	US
Telephone Number	:	214-287-3501
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARK CONAL O'NEAL
Credential	:	MS LCDC
Telephone Number	:	214-475-3712

Provider Enumeration Date	:	11/06/2013
Last Update Date	:	11/06/2013

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