Provider Demographics
NPI:1891952461
Name:DALLAS MEDICAL, PLLC
Entity Type:Organization
Organization Name:DALLAS MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:LAKSHMI-DEVI
Authorized Official - Last Name:MUMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-646-8880
Mailing Address - Street 1:9900 N CENTRAL EXPY STE 225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0918
Mailing Address - Country:US
Mailing Address - Phone:469-646-8880
Mailing Address - Fax:469-646-8884
Practice Address - Street 1:9900 N CENTRAL EXPY STE 225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0918
Practice Address - Country:US
Practice Address - Phone:469-646-8880
Practice Address - Fax:469-646-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8180207R00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z907OtherMEDICARE