Provider Demographics
NPI:1477937597
Name:HEALTHCARE ASSOCIATES OF IRVING, LLP
Entity Type:Organization
Organization Name:HEALTHCARE ASSOCIATES OF IRVING, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LIESVELD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:972-258-7499
Mailing Address - Street 1:1110 COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6117
Mailing Address - Country:US
Mailing Address - Phone:972-258-7499
Mailing Address - Fax:
Practice Address - Street 1:1110 COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6117
Practice Address - Country:US
Practice Address - Phone:972-258-7499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128468261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
0070AUMedicare PIN