Provider Demographics
NPI:1689822744
Name:C. CORDELL ADAMS MD PA
Entity Type:Organization
Organization Name:C. CORDELL ADAMS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:CORDELL
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-826-7231
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 858
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-826-7231
Mailing Address - Fax:214-826-7984
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 858
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-826-7231
Practice Address - Fax:214-826-7984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2202261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033973101Medicaid
TXE90351Medicare UPIN
TX033973101Medicaid