Provider Demographics
NPI:1568740652
Name:MEDICAL CLINIC OF NORTH TEXAS PLLC
Entity Type:Organization
Organization Name:MEDICAL CLINIC OF NORTH TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-514-5200
Mailing Address - Street 1:9003 AIRPORT FWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7770
Mailing Address - Country:US
Mailing Address - Phone:817-514-5200
Mailing Address - Fax:817-514-5210
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-996-5735
Practice Address - Fax:972-996-5736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies