Provider Demographics
NPI:1942634241
Name:RELIANT FAMILY MEDICINE & PEDIATRICS
Entity Type:Organization
Organization Name:RELIANT FAMILY MEDICINE & PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NGYIA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, NP
Authorized Official - Phone:214-277-3305
Mailing Address - Street 1:1625 N STORY RD
Mailing Address - Street 2:148
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-1945
Mailing Address - Country:US
Mailing Address - Phone:972-513-1900
Mailing Address - Fax:
Practice Address - Street 1:1625 N STORY RD
Practice Address - Street 2:148
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-1945
Practice Address - Country:US
Practice Address - Phone:972-513-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX796648261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care