Provider Demographics
NPI:1730818527
Name:COMPLEX HEALTHCARE PHYSICIANS GROUP INC
Entity type:Organization
Organization Name:COMPLEX HEALTHCARE PHYSICIANS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:817-735-1180
Mailing Address - Street 1:4201 INTERWAY PL STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-5668
Mailing Address - Country:US
Mailing Address - Phone:817-735-1180
Mailing Address - Fax:
Practice Address - Street 1:4201 INTERWAY PL STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5668
Practice Address - Country:US
Practice Address - Phone:817-735-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty