Provider Demographics
NPI:1932660636
Name:DALLAS 365, PLLC
Entity Type:Organization
Organization Name:DALLAS 365, PLLC
Other - Org Name:365 HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-422-0633
Mailing Address - Street 1:13101 PRESTON RD # 110648
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5237
Mailing Address - Country:US
Mailing Address - Phone:512-422-0633
Mailing Address - Fax:
Practice Address - Street 1:5521 BELLAIRE DR S STE 110
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5855
Practice Address - Country:US
Practice Address - Phone:817-926-9642
Practice Address - Fax:817-926-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty