Provider Demographics
NPI:1760069348
Name:NORTH TEXAS PHYSICIANS GROUP
Entity Type:Organization
Organization Name:NORTH TEXAS PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SENKUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-457-1206
Mailing Address - Street 1:1120 SHADETREE LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5415
Mailing Address - Country:US
Mailing Address - Phone:972-457-1206
Mailing Address - Fax:
Practice Address - Street 1:825 WATTERS CREEK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3770
Practice Address - Country:US
Practice Address - Phone:972-457-1206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty