Provider Demographics
NPI:1710419809
Name:MARY E RIXFORD LLC
Entity Type:Organization
Organization Name:MARY E RIXFORD LLC
Other - Org Name:MARY E RIXFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIXFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-356-6526
Mailing Address - Street 1:5906 BUFFRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2330
Mailing Address - Country:US
Mailing Address - Phone:972-788-0990
Mailing Address - Fax:
Practice Address - Street 1:6750 HILLCREST PLAZA DR
Practice Address - Street 2:SUITE 222
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1400
Practice Address - Country:US
Practice Address - Phone:214-533-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 11131261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)