Provider Demographics
NPI:1639772056
Name:ICS TRANSITIONAL MEDICINE PLLC
Entity type:Organization
Organization Name:ICS TRANSITIONAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZENAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-420-5527
Mailing Address - Street 1:4835 LBJ FWY STE 900
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6001
Mailing Address - Country:US
Mailing Address - Phone:469-420-5527
Mailing Address - Fax:
Practice Address - Street 1:4835 LBJ FWY STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6001
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty