Provider Demographics
NPI:1861702037
Name:TEXAS VISITING DOCTORS MANAGEMENT LLC
Entity type:Organization
Organization Name:TEXAS VISITING DOCTORS MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-606-0075
Mailing Address - Street 1:3121 SOUTH CARRIER
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14275 MIDWAY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3614
Practice Address - Country:US
Practice Address - Phone:972-572-1998
Practice Address - Fax:972-572-4842
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS VISITING DOCTORS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-20
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE20070Medicare UPIN