Provider Demographics
NPI:1063820173
Name:WILLIAM MUSGRAVE MHT LLC
Entity Type:Organization
Organization Name:WILLIAM MUSGRAVE MHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-753-7300
Mailing Address - Street 1:1515 HERITAGE DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3379
Mailing Address - Country:US
Mailing Address - Phone:855-860-2109
Mailing Address - Fax:
Practice Address - Street 1:300 N RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4235
Practice Address - Country:US
Practice Address - Phone:855-860-2109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty