Provider Demographics
NPI:1073805958
Name:OCCUMED PLUS - MCKINNEY
Entity Type:Organization
Organization Name:OCCUMED PLUS - MCKINNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLEBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-394-9570
Mailing Address - Street 1:PO BOX 462284
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75046-2284
Mailing Address - Country:US
Mailing Address - Phone:972-494-1419
Mailing Address - Fax:
Practice Address - Street 1:130 S CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3742
Practice Address - Country:US
Practice Address - Phone:972-548-5356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty