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NPI Code Detail

MEDICARE: PHYSICIANS MANAGEMENT SERVICES LLC

MEDICARE: PHYSICIANS MANAGEMENT SERVICES LLC
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
1101YP2500XProfessional Counselor15980TX
2101YP2500XProfessional Counselor20025TX
3101YP2500XProfessional Counselor17173TX
4103T00000XPsychologist21357TX
5225100000XPhysical Therapist1030278TX
6225100000XPhysical Therapist1014587TX
7208D00000XGeneral Practice PhysicianJ1957TX

General Provider Information

NPI Number : 1386780336
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIANS MANAGEMENT SERVICES LLC
Provider Business Mailing Address
First Line : 5931 DESCO DR
Second Line :
City : DALLAS
State : TX
Zip : 75225-1604
Country : US
Telephone Number : 214-563-5122
Fax Number : 214-361-1235
Provider Business Practice Location Address
First Line : 185 EASTGATE PLZ
Second Line :
City : WACO
State : TX
Zip : 76705-2868
Country : US
Telephone Number : 254-412-2667
Fax Number : 254-798-5766
Authorized Official
Title or Position : CEO
Name : NAT MANGUM
Credential :
Telephone Number : 469-688-6628
Provider Enumeration Date : 01/29/2007
Last Update Date : 04/22/2009

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Directions to “PHYSICIANS MANAGEMENT SERVICES LLC ” Practice Location

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