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NPI Code Detail

MEDICARE: LIFESTREAM HEALTH CENTER PA

MEDICARE: LIFESTREAM HEALTH CENTER PA
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
1174400000XSpecialistH6110TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1H6110OTHERTXTEXAS MEDICAL BOARD LICENSE

General Provider Information

NPI Number : 1235363409
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFESTREAM HEALTH CENTER PA
Provider Business Mailing Address
First Line : 705 MAIN STREET
Second Line :
City : COPPELL
State : TX
Zip : 75019
Country : US
Telephone Number : 972-304-6400
Fax Number : 972-304-6455
Provider Business Practice Location Address
First Line : 705 MAIN ST
Second Line :
City : COPPELL
State : TX
Zip : 75019-4742
Country : US
Telephone Number : 972-304-6400
Fax Number : 972-304-6455
Authorized Official
Title or Position : PRESIDENT
Name : DR. BRANDON C CHARLES
Credential : M.D.
Telephone Number : 972-304-6400
Provider Enumeration Date : 05/04/2009
Last Update Date : 03/29/2016

Similar Medicare Providers

1366447211 — DR. SHAROLYN K. DIHIGO DNP, RN, CPNP, FNP-C
Practice Location Address:
705 MAIN ST
COPPELL, TX
75019-4742
Practice Phone: 972-304-6400
Practice Fax: 972-304-6455
1609833276 — BRANDON C CHARLES MD
Practice Location Address:
705 MAIN ST
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1689707515 — MICHAEL D SULLIVAN PA
Practice Location Address:
705 MAIN ST
COPPELL, TX
75019-4742
Practice Phone: 972-304-6400
Practice Fax:
1962879015 — DR. SCHARLENE KAY GAUDET DC, DACNB
Practice Location Address:
705 MAIN ST
COPPELL, TX
75019-4742
Practice Phone: 469-790-7343
Practice Fax: 972-304-6455
1598341588 — JANA ELISABETH ROGERS FNP-C
Practice Location Address:
705 MAIN ST
COPPELL, TX
75019-4742
Practice Phone: 972-440-2359
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1578677332 — RIVERCHASE REHAB & WELLNESS PA
Practice Location Address:
870 S DENTON TAP RD STE 200
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75019-4575
Practice Phone: 972-393-3737
Practice Fax: 972-393-4925

Directions to “LIFESTREAM HEALTH CENTER PA ” Practice Location

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