Provider Demographics
NPI:1336578152
Name:MEDALIST DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:MEDALIST DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-979-6222
Mailing Address - Street 1:1105 EASTVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5431
Mailing Address - Country:US
Mailing Address - Phone:972-979-6222
Mailing Address - Fax:972-853-8827
Practice Address - Street 1:1105 EASTVIEW CIR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5431
Practice Address - Country:US
Practice Address - Phone:972-979-6222
Practice Address - Fax:972-853-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty