MEDICARE: HIPPOMED WELLNESS CLINICS LIMITED COMPANY

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	261Q00000X	Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1982214375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIPPOMED WELLNESS CLINICS LIMITED COMPANY

Provider Business Mailing Address
First Line	:	5930 LBJ FWY STE 380
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6370
Country	:	US
Telephone Number	:	972-803-6008
Fax Number	:	469-460-6558

Provider Business Practice Location Address
First Line	:	5930 LBJ FWY STE 380
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6370
Country	:	US
Telephone Number	:	972-803-6008
Fax Number	:	469-460-6558

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. CHRIS BROWN
Credential	:
Telephone Number	:	253-709-6790

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	07/31/2020

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