Provider Demographics
NPI:1548409634
Name:TERRELL MEDICAL CLINIC & REHAB PA
Entity Type:Organization
Organization Name:TERRELL MEDICAL CLINIC & REHAB PA
Other - Org Name:DALLAS MEDICAL CLINIC AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:D
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-563-1636
Mailing Address - Street 1:1553 HIGHWAY 34 S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-4833
Mailing Address - Country:US
Mailing Address - Phone:972-563-1636
Mailing Address - Fax:972-551-6968
Practice Address - Street 1:1553 HIGHWAY 34 S
Practice Address - Street 2:SUITE 300
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-4833
Practice Address - Country:US
Practice Address - Phone:972-563-1636
Practice Address - Fax:972-551-6968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARON D. PADILLA M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-12
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2254207QS0010X
TX558614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty