Provider Demographics
NPI:1750674172
Name:USA MEDICAL, PA
Entity Type:Organization
Organization Name:USA MEDICAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:240-235-5895
Mailing Address - Street 1:PO BOX 797604
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-7604
Mailing Address - Country:US
Mailing Address - Phone:214-235-5895
Mailing Address - Fax:214-276-1359
Practice Address - Street 1:2410 W MEMORIAL RD
Practice Address - Street 2:SUITE C432
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-8047
Practice Address - Country:US
Practice Address - Phone:240-235-5895
Practice Address - Fax:214-276-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3775363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty