Provider Demographics
NPI:1356869630
Name:PMST RED OAK, LLC
Entity type:Organization
Organization Name:PMST RED OAK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:TEAL
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-473-8980
Mailing Address - Street 1:6001 WINDHAVEN PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8022
Mailing Address - Country:US
Mailing Address - Phone:972-473-8980
Mailing Address - Fax:972-212-6851
Practice Address - Street 1:100 BONHAM CT STE A
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-4665
Practice Address - Country:US
Practice Address - Phone:972-473-8980
Practice Address - Fax:972-212-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty