Provider Demographics
NPI:1518151422
Name:GREATER SOUTHWEST INJURY & REHAB INC.
Entity Type:Organization
Organization Name:GREATER SOUTHWEST INJURY & REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-522-1511
Mailing Address - Street 1:2304 BARDIN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3850
Mailing Address - Country:US
Mailing Address - Phone:972-522-1511
Mailing Address - Fax:972-522-1510
Practice Address - Street 1:2304 BARDIN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3850
Practice Address - Country:US
Practice Address - Phone:972-522-1511
Practice Address - Fax:972-522-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF007414261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center