MEDICARE: PEDIATRIC PERIOPERATIVE CONSULTANTS OF N. TX., 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	2080P0203X	Pediatric Critical Care Medicine Physician

General Provider Information

NPI Number	:	1578970307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PERIOPERATIVE CONSULTANTS OF N. TX., PLLC

Provider Business Mailing Address
First Line	:	7777 FOREST LN STE D569
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-6903
Country	:	US
Telephone Number	:	972-566-8340
Fax Number	:	972-566-8338

Provider Business Practice Location Address
First Line	:	7777 FOREST LN STE D569
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-6903
Country	:	US
Telephone Number	:	972-566-8340
Fax Number	:	972-566-8338

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES R MATSON
Credential	:	MD
Telephone Number	:	972-566-8340

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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