Provider Demographics
NPI:1104850361
Name:DRS TSCHUMY HERRING KALISER TRUE REARDON JONES A MEDICAL ASSOCIATION
Entity Type:Organization
Organization Name:DRS TSCHUMY HERRING KALISER TRUE REARDON JONES A MEDICAL ASSOCIATION
Other - Org Name:HARVILL TSCHUMY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-369-8101
Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:SUITE 505
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4405
Mailing Address - Country:US
Mailing Address - Phone:214-369-8101
Mailing Address - Fax:214-369-7318
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:SUITE 505
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:214-369-8101
Practice Address - Fax:214-369-7318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBC48OtherMEDICARE NUMBER
TXT531OtherMEDICARE NUMBER
TXB584Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER