Provider Demographics
NPI:1184854309
Name:MEDICAL CLINIC OF NORTH TEXAS PLLC
Entity Type:Organization
Organization Name:MEDICAL CLINIC OF NORTH TEXAS PLLC
Other - Org Name:USMD PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CPO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-493-4015
Mailing Address - Street 1:2801 GATEWAY DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2694
Mailing Address - Country:US
Mailing Address - Phone:972-847-0792
Mailing Address - Fax:817-419-4605
Practice Address - Street 1:5450 CLEARFORK MAIN STREET
Practice Address - Street 2:SUITE 410
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76019-3559
Practice Address - Country:US
Practice Address - Phone:817-505-0233
Practice Address - Fax:817-332-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1101300002Medicare NSC