Provider Demographics
NPI:1013147792
Name:ORSEL S. MCGHEE III M.D., P.A.
Entity type:Organization
Organization Name:ORSEL S. MCGHEE III M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-563-8100
Mailing Address - Street 1:1151 N BUCKNER BLVD
Mailing Address - Street 2:STE 301A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3426
Mailing Address - Country:US
Mailing Address - Phone:214-324-2401
Mailing Address - Fax:214-321-5052
Practice Address - Street 1:617 W MOORE AVE
Practice Address - Street 2:STE B
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3123
Practice Address - Country:US
Practice Address - Phone:972-563-8100
Practice Address - Fax:972-563-2684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0864174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2175101-01Medicaid
TX030235801Medicaid
TX2175101-01Medicaid