Provider Demographics
NPI:1619373719
Name:DALLAS INTEGRATED MEDICAL CENTER INC
Entity Type:Organization
Organization Name:DALLAS INTEGRATED MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:TURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-941-4154
Mailing Address - Street 1:2351 W NORTHWEST HWY
Mailing Address - Street 2:SUITE # 3355
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4433
Mailing Address - Country:US
Mailing Address - Phone:469-941-4154
Mailing Address - Fax:469-941-4149
Practice Address - Street 1:2351 W NORTHWEST HWY
Practice Address - Street 2:SUITE # 3355
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4433
Practice Address - Country:US
Practice Address - Phone:469-941-4154
Practice Address - Fax:469-941-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty