Provider Demographics
NPI:1861932592
Name:TEXAS PREMIER INDEPENDENT PHYSICIAN MANAGEMENT, LLC
Entity type:Organization
Organization Name:TEXAS PREMIER INDEPENDENT PHYSICIAN MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-442-5209
Mailing Address - Street 1:2871 LAKE VISTA DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067
Mailing Address - Country:US
Mailing Address - Phone:940-442-5209
Mailing Address - Fax:940-222-2720
Practice Address - Street 1:2871 LAKE VISTA DR
Practice Address - Street 2:SUITE 210
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067
Practice Address - Country:US
Practice Address - Phone:940-442-5209
Practice Address - Fax:940-222-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center