Provider Demographics
NPI:1497333959
Name:INTREPID OF THE METROPLEX, INC.
Entity Type:Organization
Organization Name:INTREPID OF THE METROPLEX, INC.
Other - Org Name:INTREPID PALLIATIVE & SUPPORTIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-445-3750
Mailing Address - Street 1:3220 KELLER SPRINGS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-5911
Mailing Address - Country:US
Mailing Address - Phone:214-542-4952
Mailing Address - Fax:214-445-3900
Practice Address - Street 1:3220 KELLER SPRINGS RD STE 108
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-5911
Practice Address - Country:US
Practice Address - Phone:214-445-3750
Practice Address - Fax:214-445-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty