Provider Demographics
NPI:1528394806
Name:ACCOMMODATING MEDICAL PROVIDERS OF TEXAS, PLLC
Entity Type:Organization
Organization Name:ACCOMMODATING MEDICAL PROVIDERS OF TEXAS, PLLC
Other - Org Name:AGING WITH CARE L, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MECHIELL
Authorized Official - Middle Name:DEMETRIUS
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:469-951-9984
Mailing Address - Street 1:3008 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5307
Mailing Address - Country:US
Mailing Address - Phone:469-951-9984
Mailing Address - Fax:
Practice Address - Street 1:3008 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5307
Practice Address - Country:US
Practice Address - Phone:469-951-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCOMMODATING MEDICAL PROVIDERS OF TEXAS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-21
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02092207QG0300X, 207RG0300X, 208D00000X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117763Medicaid