Provider Demographics
NPI:1760139588
Name:MD VISIT, LLC
Entity Type:Organization
Organization Name:MD VISIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:SALALILA
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-880-9993
Mailing Address - Street 1:8000 CALMONT AVE UNIT 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-3802
Mailing Address - Country:US
Mailing Address - Phone:972-880-9993
Mailing Address - Fax:972-688-6042
Practice Address - Street 1:8000 CALMONT AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-3802
Practice Address - Country:US
Practice Address - Phone:972-880-9993
Practice Address - Fax:972-688-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty