MEDICARE: SUREPOINT EMERGENCY PHYSICIANS DENTON, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1194198101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUREPOINT EMERGENCY PHYSICIANS DENTON, PLLC

Provider Business Mailing Address
First Line	:	2300 MATLOCK RD STE 35
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-5018
Country	:	US
Telephone Number	:	469-830-8200
Fax Number	:	469-830-8201

Provider Business Practice Location Address
First Line	:	2426 LILLIAN MILLER PKWY
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-2908
Country	:	US
Telephone Number	:	940-218-6712
Fax Number	:	940-218-6715

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHELLE NEWSOM
Credential	:
Telephone Number	:	469-830-8200

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	05/15/2023

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