Provider Demographics
NPI:1891067914
Name:CENTRAL TEXAS MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:CENTRAL TEXAS MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-870-8133
Mailing Address - Street 1:PO BOX 543539
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-3539
Mailing Address - Country:US
Mailing Address - Phone:214-870-8133
Mailing Address - Fax:817-592-3025
Practice Address - Street 1:7227 CANA
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6860
Practice Address - Country:US
Practice Address - Phone:214-870-8133
Practice Address - Fax:817-592-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0664261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN0664OtherMEDICAL LICENCE