Provider Demographics
NPI:1245569946
Name:INDELIBLE HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:INDELIBLE HEALTH & WELLNESS LLC
Other - Org Name:TEXAS VISITING DOCTORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICE MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-266-5354
Mailing Address - Street 1:2601 TANDY AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103
Mailing Address - Country:US
Mailing Address - Phone:972-266-5354
Mailing Address - Fax:972-266-7876
Practice Address - Street 1:3121 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3734
Practice Address - Country:US
Practice Address - Phone:972-266-5354
Practice Address - Fax:972-266-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20070Medicare UPIN