Provider Demographics
NPI:1497123913
Name:ACO MEDICAL, PLLC
Entity Type:Organization
Organization Name:ACO MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:RIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-543-8294
Mailing Address - Street 1:PO BOX 794126
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-4126
Mailing Address - Country:US
Mailing Address - Phone:972-314-9906
Mailing Address - Fax:972-314-9993
Practice Address - Street 1:2705 HOSPITAL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-0928
Practice Address - Country:US
Practice Address - Phone:972-314-9906
Practice Address - Fax:972-314-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330082Medicare PIN