Provider Demographics
NPI:1194858977
Name:EBIE COMMUNITY MEDICAL PLLC
Entity Type:Organization
Organization Name:EBIE COMMUNITY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VELESA
Authorized Official - Middle Name:PRISCILLA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-224-3434
Mailing Address - Street 1:1670 N HAMPTON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8302
Mailing Address - Country:US
Mailing Address - Phone:972-224-3434
Mailing Address - Fax:972-224-3442
Practice Address - Street 1:1670 N HAMPTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8302
Practice Address - Country:US
Practice Address - Phone:972-224-3434
Practice Address - Fax:972-224-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C2293Medicare ID - Type UnspecifiedMEDICARE DR O