Provider Demographics
NPI:1922494293
Name:RED BIRD URGENT CARE CLINIC, P.A.
Entity Type:Organization
Organization Name:RED BIRD URGENT CARE CLINIC, P.A.
Other - Org Name:RED BIRD PAIN MANAGEMENT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAZUANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-744-7524
Mailing Address - Street 1:PO BOX 6539
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4323 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1058
Practice Address - Country:US
Practice Address - Phone:214-330-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty