Provider Demographics
NPI:1144608191
Name:PSMD MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:PSMD MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DURGA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:MEKALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-987-1414
Mailing Address - Street 1:8912 WOODWAY DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4480
Mailing Address - Country:US
Mailing Address - Phone:817-987-1414
Mailing Address - Fax:817-987-1425
Practice Address - Street 1:3132 MATLOCK RD
Practice Address - Street 2:SUITE 311
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2910
Practice Address - Country:US
Practice Address - Phone:817-987-1414
Practice Address - Fax:817-987-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8039207Q00000X
TXP0385208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty