Provider Demographics
NPI:1467863688
Name:PROMEDICAL CARE PLLC
Entity Type:Organization
Organization Name:PROMEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMONET
Authorized Official - Middle Name:
Authorized Official - Last Name:ABULOC
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-714-0117
Mailing Address - Street 1:2605 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-0901
Mailing Address - Country:US
Mailing Address - Phone:214-714-0117
Mailing Address - Fax:469-298-3335
Practice Address - Street 1:2605 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-0901
Practice Address - Country:US
Practice Address - Phone:214-714-0117
Practice Address - Fax:469-298-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty