MEDICARE: COMMUNITYMED PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QP2300X	Primary Care Clinic/Center
2	261QX0100X	Occupational Medicine Clinic/Center
3	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1821417072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITYMED PLLC

Provider Business Mailing Address
First Line	:	16775 ADDISON RD STE 200
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-5654
Country	:	US
Telephone Number	:	972-464-1611
Fax Number	:	972-464-1611

Provider Business Practice Location Address
First Line	:	3591 MCKINNEY ST
Second Line	:	SUITE 200
City	:	MELISSA
State	:	TX
Zip	:	75454-9571
Country	:	US
Telephone Number	:	972-464-1611
Fax Number	:	972-464-1611

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. GREGORY BLOMQUIST
Credential	:	MD
Telephone Number	:	469-360-3498

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	06/03/2021

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