Provider Demographics
NPI:1053500082
Name:SPECIALITY AMBULATORY CENTER OF TEXAS
Entity Type:Organization
Organization Name:SPECIALITY AMBULATORY CENTER OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHISENANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-276-6300
Mailing Address - Street 1:6505 W. PARK BLVD. #306 (285)
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-276-6300
Mailing Address - Fax:
Practice Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 103
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4277
Practice Address - Country:US
Practice Address - Phone:972-276-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7725261QM1300X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612117Medicare PIN