Provider Demographics
NPI:1639506173
Name:WCML MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:WCML MANAGEMENT SERVICES, LLC
Other - Org Name:MEN'S EDGE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-996-0900
Mailing Address - Street 1:5550 LBJ FWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6217
Mailing Address - Country:US
Mailing Address - Phone:972-996-0900
Mailing Address - Fax:972-996-0905
Practice Address - Street 1:5550 LBJ FWY
Practice Address - Street 2:SUITE 360
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6217
Practice Address - Country:US
Practice Address - Phone:972-996-0900
Practice Address - Fax:972-996-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Single Specialty