Provider Demographics
NPI:1346998713
Name:DIVINETOUCH MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:DIVINETOUCH MEDICAL CENTER LLC
Other - Org Name:DIVINETOUCH MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLA-PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-932-7336
Mailing Address - Street 1:304 N MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3449
Mailing Address - Country:US
Mailing Address - Phone:682-422-9950
Mailing Address - Fax:
Practice Address - Street 1:304 N MITCHELL RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3449
Practice Address - Country:US
Practice Address - Phone:682-422-9950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty