Provider Demographics
NPI:1790179802
Name:SPECIALTY CLINICS OF DALLAS
Entity Type:Organization
Organization Name:SPECIALTY CLINICS OF DALLAS
Other - Org Name:EXCEL FAMILY MEDICINE & PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-206-2630
Mailing Address - Street 1:2707 BOLTON BOONE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2077
Mailing Address - Country:US
Mailing Address - Phone:469-206-2630
Mailing Address - Fax:214-730-4281
Practice Address - Street 1:2707 BOLTON BOONE DR STE 100
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2077
Practice Address - Country:US
Practice Address - Phone:469-206-2630
Practice Address - Fax:214-730-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125211261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty