Provider Demographics
NPI:1598276610
Name:HEALTHPROS MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:HEALTHPROS MEDICAL CENTER, PLLC
Other - Org Name:HEALTHPROS MEDICAL CENTER, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHROMACHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-200-1691
Mailing Address - Street 1:4303 BUENA VISTA ST APT 304
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4860
Mailing Address - Country:US
Mailing Address - Phone:701-200-1691
Mailing Address - Fax:
Practice Address - Street 1:2548 TARPLEY RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2328
Practice Address - Country:US
Practice Address - Phone:214-742-8387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty