MEDICARE: NORTH TEXAS FLU SHOTS 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
1	2083P0901X	Public Health & General Preventive Medicine Physician	J5523	TX

General Provider Information

NPI Number	:	1558590737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS FLU SHOTS LLC

Provider Business Mailing Address
First Line	:	4011 W PLANO PKWY
Second Line	:	SUITE 106B
City	:	PLANO
State	:	TX
Zip	:	75093-5629
Country	:	US
Telephone Number	:	214-504-5215
Fax Number	:

Provider Business Practice Location Address
First Line	:	4011 W PLANO PKWY
Second Line	:	SUITE 106B
City	:	PLANO
State	:	TX
Zip	:	75093-5629
Country	:	US
Telephone Number	:	214-504-5215
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ARTHUR STANLEY DAWSON
Credential	:
Telephone Number	:	469-569-7162

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	08/18/2010

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