Provider Demographics
NPI:1336218130
Name:NORTH TEXAS IME
Entity Type:Organization
Organization Name:NORTH TEXAS IME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:WARME
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-258-5900
Mailing Address - Street 1:2940 N O CONNOR RD STE 117
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-8802
Mailing Address - Country:US
Mailing Address - Phone:972-258-5900
Mailing Address - Fax:972-258-5904
Practice Address - Street 1:2940 N O CONNOR RD STE 117
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-8802
Practice Address - Country:US
Practice Address - Phone:972-258-5900
Practice Address - Fax:972-258-5904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB25068Medicare UPIN