Provider Demographics
NPI:1083181846
Name:MANAGED SERVICE GROUP
Entity Type:Organization
Organization Name:MANAGED SERVICE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-516-7760
Mailing Address - Street 1:PO BOX 3554
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8194
Mailing Address - Country:US
Mailing Address - Phone:214-536-4818
Mailing Address - Fax:
Practice Address - Street 1:22 BRIERCROFT OFFICE PARK STE 3
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-3089
Practice Address - Country:US
Practice Address - Phone:800-516-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care