Provider Demographics
NPI:1609427707
Name:JIRCIK MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:JIRCIK MEDICAL GROUP, PLLC
Other - Org Name:JIRCIK MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:JIRCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:181-755-1540
Mailing Address - Street 1:12001 SOUTH FWY STE 304
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7215
Mailing Address - Country:US
Mailing Address - Phone:817-551-5400
Mailing Address - Fax:
Practice Address - Street 1:12001 SOUTH FWY STE 304
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7215
Practice Address - Country:US
Practice Address - Phone:817-551-5400
Practice Address - Fax:817-568-0961
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JIRCK MEDICAL GROUP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-20
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty