Provider Demographics
NPI:1629024443
Name:HOUSECALL DOCTORS OF NORTH TEXAS PA
Entity Type:Organization
Organization Name:HOUSECALL DOCTORS OF NORTH TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-244-0220
Mailing Address - Street 1:2400 HIGH RIDGE RD
Mailing Address - Street 2:SUITE 101 AND 103
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8725
Mailing Address - Country:US
Mailing Address - Phone:561-244-0220
Mailing Address - Fax:561-244-0222
Practice Address - Street 1:6310 LBJ FWY
Practice Address - Street 2:SUITE 208
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6401
Practice Address - Country:US
Practice Address - Phone:561-244-0220
Practice Address - Fax:561-244-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00724ZMedicare PIN