Provider Demographics
NPI:1144689373
Name:MAINMEDPLUS
Entity type:Organization
Organization Name:MAINMEDPLUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-392-6700
Mailing Address - Street 1:3044 OLD DENTON RD
Mailing Address - Street 2:STE 115
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5016
Mailing Address - Country:US
Mailing Address - Phone:972-245-2876
Mailing Address - Fax:972-905-7487
Practice Address - Street 1:3044 OLD DENTON RD
Practice Address - Street 2:STE 115
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5016
Practice Address - Country:US
Practice Address - Phone:972-245-2876
Practice Address - Fax:972-905-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2988261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care