Provider Demographics
NPI:1114239076
Name:TURTLE CREEK MEDICAL MANAGEMENT CORP
Entity Type:Organization
Organization Name:TURTLE CREEK MEDICAL MANAGEMENT CORP
Other - Org Name:TURTLE CREEK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-526-1133
Mailing Address - Street 1:3131 TURTLE CREEK BLVD
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5405
Mailing Address - Country:US
Mailing Address - Phone:214-526-1133
Mailing Address - Fax:214-526-1136
Practice Address - Street 1:3131 TURTLE CREEK BLVD
Practice Address - Street 2:SUITE 1101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5405
Practice Address - Country:US
Practice Address - Phone:214-526-1133
Practice Address - Fax:214-526-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP3300X261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain