Provider Demographics
NPI:1477740231
Name:FRISCO MEDICAL SURGICAL CLINIC
Entity Type:Organization
Organization Name:FRISCO MEDICAL SURGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:BLACKMON
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-377-2447
Mailing Address - Street 1:8680 W MAIN ST
Mailing Address - Street 2:1W
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3096
Mailing Address - Country:US
Mailing Address - Phone:972-377-2447
Mailing Address - Fax:972-377-3006
Practice Address - Street 1:8680 W MAIN ST
Practice Address - Street 2:1W
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3096
Practice Address - Country:US
Practice Address - Phone:972-377-2447
Practice Address - Fax:972-377-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N05FMedicare PIN