Provider Demographics
NPI:1851057079
Name:CARROLLTON FIRST CARE MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:CARROLLTON FIRST CARE MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-531-3990
Mailing Address - Street 1:2625 OLD DENTON RD STE 415
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5112
Mailing Address - Country:US
Mailing Address - Phone:972-242-3361
Mailing Address - Fax:972-242-5678
Practice Address - Street 1:2625 OLD DENTON RD STE 415
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5112
Practice Address - Country:US
Practice Address - Phone:972-242-3361
Practice Address - Fax:972-242-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty