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NPI Code Detail

MEDICARE: PHYCARE SERVICES INC

MEDICARE: PHYCARE SERVICES INC
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
1208600000XSurgery PhysicianG37993TX

General Provider Information

NPI Number : 1487077111
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYCARE SERVICES INC
Provider Business Mailing Address
First Line : 2201 MAIN ST
Second Line : 1225
City : DALLAS
State : TX
Zip : 75201-4327
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2201 MAIN ST
Second Line : 1225
City : DALLAS
State : TX
Zip : 75201-4327
Country : US
Telephone Number : 817-526-2882
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : ROOSEVELT GILMORE I
Credential :
Telephone Number : 817-526-2882
Provider Enumeration Date : 01/31/2014
Last Update Date : 01/31/2014

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Directions to “PHYCARE SERVICES INC ” Practice Location

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