MEDICARE: TEXAS MEDICAL RECOVERY 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	2084P0800X	Psychiatry Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1255993713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS MEDICAL RECOVERY GROUP PLLC

Provider Business Mailing Address
First Line	:	4001 MAPLE AVE STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3241
Country	:	US
Telephone Number	:	214-817-4964
Fax Number	:	210-634-3961

Provider Business Practice Location Address
First Line	:	4901 PADRE BLVD
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597-7320
Country	:	US
Telephone Number	:	956-299-4748
Fax Number	:	210-634-3961

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ADAM BIANCHINI
Credential	:	MD
Telephone Number	:	561-841-1051

Provider Enumeration Date	:	07/05/2019
Last Update Date	:	07/08/2019

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