Provider Demographics
NPI:1164567129
Name:TEXASMD MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:TEXASMD MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEIKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-739-6100
Mailing Address - Street 1:3241 PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-7634
Mailing Address - Country:US
Mailing Address - Phone:214-739-6100
Mailing Address - Fax:
Practice Address - Street 1:8305 WALNUT HILL LN
Practice Address - Street 2:SUITE 140
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4217
Practice Address - Country:US
Practice Address - Phone:214-739-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG34243Medicare UPIN