Provider Demographics
NPI:1578948386
Name:ECLIPSE MEDICAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:ECLIPSE MEDICAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-479-0800
Mailing Address - Street 1:5750 RUFE SNOW DR STE 108
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6140
Mailing Address - Country:US
Mailing Address - Phone:817-479-0800
Mailing Address - Fax:817-479-0801
Practice Address - Street 1:2401 IRA E WOODS AVE STE 600
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8631
Practice Address - Country:US
Practice Address - Phone:817-488-9991
Practice Address - Fax:817-488-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology