Provider Demographics
NPI:1144262296
Name:ACCUCARE FAMILY MEDICAL CENTER P.A.
Entity type:Organization
Organization Name:ACCUCARE FAMILY MEDICAL CENTER P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:THERIOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-816-0459
Mailing Address - Street 1:709 WEST RUSK STREET, SUITE B, #867
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087
Mailing Address - Country:US
Mailing Address - Phone:972-786-0140
Mailing Address - Fax:972-786-0142
Practice Address - Street 1:1650 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3565
Practice Address - Country:US
Practice Address - Phone:972-816-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9578207Q00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX779135OtherAETNA
TX153019801Medicaid
TX12622OtherPARKLAND
TX153019801Medicaid
TX779135OtherAETNA