MEDICARE: NATIONAL MEDICAL PROFESSIONALS OF GREATER TEXAS 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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306355011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL MEDICAL PROFESSIONALS OF GREATER TEXAS PLLC

Provider Business Mailing Address
First Line	:	220 LAS COLINAS BLVD E STE 1000
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-5500
Country	:	US
Telephone Number	:	972-899-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530 TEZEL RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-4194
Country	:	US
Telephone Number	:	972-899-6996
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	DONALD LYLES
Credential	:
Telephone Number	:	972-899-6666

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	03/28/2018

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