Provider Demographics
NPI:1457465486
Name:TRESTER FAMILY MEDICAL GROUP
Entity Type:Organization
Organization Name:TRESTER FAMILY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:KEEN
Authorized Official - Last Name:TRESTER
Authorized Official - Suffix:III
Authorized Official - Credentials:NP
Authorized Official - Phone:972-424-7000
Mailing Address - Street 1:900 E PARK BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5465
Mailing Address - Country:US
Mailing Address - Phone:972-424-7000
Mailing Address - Fax:972-424-7001
Practice Address - Street 1:900 E PARK BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5465
Practice Address - Country:US
Practice Address - Phone:972-424-7000
Practice Address - Fax:972-424-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4313207R00000X
TX633384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15443Medicaid
TX0056MSOtherBC/BS ID NUMBER
TX10011656Medicaid
TX=========OtherUNITED HEALTHCARE
TX10011656Medicaid
TX15443Medicaid