Provider Demographics
NPI:1043261787
Name:NORTH CENTRAL TEXAS PHYSICAL MEDICINE & REHABILITATION PA
Entity Type:Organization
Organization Name:NORTH CENTRAL TEXAS PHYSICAL MEDICINE & REHABILITATION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-619-5425
Mailing Address - Street 1:9720 COIT RD # 220-262
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5833
Mailing Address - Country:US
Mailing Address - Phone:214-619-5425
Mailing Address - Fax:214-619-5427
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:214-619-5425
Practice Address - Fax:214-619-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC9032OtherMEDICARE RR GROUP NUMBER
TX0080KZOtherBCBS GROUP NUMBER
TX164699401Medicaid
DC9032OtherMEDICARE RR GROUP NUMBER