Provider Demographics
NPI:1407968316
Name:MEDICAL CLINIC OF NORTH TEXAS, P.A.
Entity Type:Organization
Organization Name:MEDICAL CLINIC OF NORTH TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:KINNEY
Authorized Official - Last Name:COUTANT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:817-514-5258
Mailing Address - Street 1:9003 AIRPORT FWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7770
Mailing Address - Country:US
Mailing Address - Phone:817-514-5200
Mailing Address - Fax:817-514-5210
Practice Address - Street 1:2501 SCRIPTURE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2313
Practice Address - Country:US
Practice Address - Phone:940-591-6600
Practice Address - Fax:940-591-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2590261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXX0143042OtherTEXAS D.P.S. NUMBER