Provider Demographics
NPI:1336882786
Name:CENTRAL MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:CENTRAL MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-760-9701
Mailing Address - Street 1:408 S CESAR CHAVEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-5808
Mailing Address - Country:US
Mailing Address - Phone:214-760-9701
Mailing Address - Fax:214-760-9708
Practice Address - Street 1:408 S CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-5808
Practice Address - Country:US
Practice Address - Phone:214-760-9701
Practice Address - Fax:214-760-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty