Provider Demographics
NPI:1396611893
Name:CLINIC AT CEDAR SPRINGS
Entity type:Organization
Organization Name:CLINIC AT CEDAR SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRIPORO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:817-903-9498
Mailing Address - Street 1:8204 ELMBROOK DR STE 263
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4067
Mailing Address - Country:US
Mailing Address - Phone:817-903-9498
Mailing Address - Fax:
Practice Address - Street 1:8204 ELMBROOK DR STE 263
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4067
Practice Address - Country:US
Practice Address - Phone:817-903-9498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty