Provider Demographics
NPI:1275025298
Name:I-35 CAPITAL PHYSICIANS GROUP, INC
Entity Type:Organization
Organization Name:I-35 CAPITAL PHYSICIANS GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-556-7186
Mailing Address - Street 1:550 BAILEY AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2100
Mailing Address - Country:US
Mailing Address - Phone:817-779-4244
Mailing Address - Fax:817-779-4429
Practice Address - Street 1:220 N RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4115
Practice Address - Country:US
Practice Address - Phone:817-556-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty