Provider Demographics
NPI:1013424514
Name:CHRONIC DISEASE MANAGEMENT CENTERS OF TEXAS
Entity Type:Organization
Organization Name:CHRONIC DISEASE MANAGEMENT CENTERS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THERESSIA
Authorized Official - Middle Name:LYDON
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-729-8750
Mailing Address - Street 1:1725 S HOUSTON SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-3926
Mailing Address - Country:US
Mailing Address - Phone:214-729-8750
Mailing Address - Fax:972-223-7383
Practice Address - Street 1:600 METHODIST ST APT 2120
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-4262
Practice Address - Country:US
Practice Address - Phone:469-552-9911
Practice Address - Fax:972-223-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2127329225200000X
251B00000X, 251J00000X, 251S00000X, 252Y00000X, 261Q00000X, 261QH0100X, 261QP2000X, 261QR0400X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty