Provider Demographics
NPI:1740388131
Name:CITYCARE CLINIC
Entity Type:Organization
Organization Name:CITYCARE CLINIC
Other - Org Name:CITYCARE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CITY SUPERVISING PHYSCIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:TIM
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-205-3727
Mailing Address - Street 1:1720 COMMERCE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040
Mailing Address - Country:US
Mailing Address - Phone:972-205-3727
Mailing Address - Fax:972-205-3444
Practice Address - Street 1:1720 COMMERCE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:972-205-3727
Practice Address - Fax:972-205-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty