Provider Demographics
NPI:1760427819
Name:UNITED HOSPICE SERVICES, INC.
Entity Type:Organization
Organization Name:UNITED HOSPICE SERVICES, INC.
Other - Org Name:DFW PRIMARY CARE PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-432-0459
Mailing Address - Street 1:2501 PARKVIEW DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5824
Mailing Address - Country:US
Mailing Address - Phone:682-432-0459
Mailing Address - Fax:682-432-0471
Practice Address - Street 1:2501 PARKVIEW DR
Practice Address - Street 2:SUITE 330
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5824
Practice Address - Country:US
Practice Address - Phone:682-432-0459
Practice Address - Fax:682-432-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z204Medicare PIN