Provider Demographics
NPI:1063835361
Name:DFW PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:DFW PRIMARY CARE PLLC
Other - Org Name:DFW GERIATRICS PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KETHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-639-5838
Mailing Address - Street 1:2925 SKYWAY CIR N
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3510
Mailing Address - Country:US
Mailing Address - Phone:972-639-5838
Mailing Address - Fax:972-791-8211
Practice Address - Street 1:2925 SKYWAY CIR N
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3510
Practice Address - Country:US
Practice Address - Phone:972-639-5838
Practice Address - Fax:972-791-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty