Provider Demographics
NPI:1043229461
Name:CARDINAL MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:CARDINAL MEDICAL SERVICES, INC.
Other - Org Name:NURSE PRACTITONER HOUSECALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, ANP
Authorized Official - Phone:817-590-2275
Mailing Address - Street 1:1615 PRECINCT LINE RD
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3345
Mailing Address - Country:US
Mailing Address - Phone:817-590-2275
Mailing Address - Fax:817-605-8779
Practice Address - Street 1:1615 PRECINCT LINE RD
Practice Address - Street 2:SUITE 105A
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3345
Practice Address - Country:US
Practice Address - Phone:817-605-8777
Practice Address - Fax:817-605-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531803363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1248650001Other1
TX1248650001Other1