Provider Demographics
NPI:1639464324
Name:BUFFALO VISTA URGENT FAMILY CARE, PLLC
Entity type:Organization
Organization Name:BUFFALO VISTA URGENT FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:IBONI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-454-2466
Mailing Address - Street 1:2033 W MCDERMOTT DR STE 320-215
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4694
Mailing Address - Country:US
Mailing Address - Phone:903-322-9309
Mailing Address - Fax:903-322-9066
Practice Address - Street 1:1045 E RAILROAD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831
Practice Address - Country:US
Practice Address - Phone:903-322-9309
Practice Address - Fax:903-322-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7424261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care