Provider Demographics
NPI:1245488436
Name:TROPHY CLUB MEDICAL SERVICES, LLP
Entity type:Organization
Organization Name:TROPHY CLUB MEDICAL SERVICES, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAINEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEE
Authorized Official - Suffix:
Authorized Official - Credentials:CMC
Authorized Official - Phone:817-430-9111
Mailing Address - Street 1:301 TROPHY LAKE DR
Mailing Address - Street 2:SUITE 136
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5238
Mailing Address - Country:US
Mailing Address - Phone:817-430-9111
Mailing Address - Fax:817-430-8911
Practice Address - Street 1:301 TROPHY LAKE DR
Practice Address - Street 2:SUITE 136
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5238
Practice Address - Country:US
Practice Address - Phone:817-430-9111
Practice Address - Fax:817-430-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty