Provider Demographics
NPI:1396210423
Name:OPEN ARMS HEALTHCARE OF TEXAS INC.
Entity Type:Organization
Organization Name:OPEN ARMS HEALTHCARE OF TEXAS INC.
Other - Org Name:MEDICO MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-831-6500
Mailing Address - Street 1:8150 SPRINGWOOD DR # 150B
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5810
Mailing Address - Country:US
Mailing Address - Phone:214-396-7397
Mailing Address - Fax:214-396-7397
Practice Address - Street 1:6909 LAKE JUNE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1325
Practice Address - Country:US
Practice Address - Phone:214-391-1900
Practice Address - Fax:214-391-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty