MEDICARE: TEXAS FOUNDATION MEDICAL GROUP, 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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1063062420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS FOUNDATION MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	8390 LYNDON B JOHNSON FWY STE 500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-1188
Country	:	US
Telephone Number	:	469-909-1312
Fax Number	:

Provider Business Practice Location Address
First Line	:	8390 LYNDON B JOHNSON FWY STE 500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-1188
Country	:	US
Telephone Number	:	469-909-1312
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JUSTIN THOMPSON
Credential	:	MD
Telephone Number	:	469-909-1312

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/18/2019

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