Provider Demographics
NPI:1346723988
Name:SOUTHWEST TRAUMA RECOVERY CLINICS
Entity Type:Organization
Organization Name:SOUTHWEST TRAUMA RECOVERY CLINICS
Other - Org Name:STAR CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHWAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-264-7225
Mailing Address - Street 1:1643 LANCASTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3593
Mailing Address - Country:US
Mailing Address - Phone:817-264-7225
Mailing Address - Fax:972-852-9094
Practice Address - Street 1:1643 LANCASTER DR STE 201
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3593
Practice Address - Country:US
Practice Address - Phone:817-264-7225
Practice Address - Fax:972-852-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty