Provider Demographics
NPI:1649028267
Name:MEDCONMD1 PLLC
Entity type:Organization
Organization Name:MEDCONMD1 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-291-7405
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-0935
Mailing Address - Country:US
Mailing Address - Phone:844-391-7277
Mailing Address - Fax:512-857-1634
Practice Address - Street 1:7502 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3802
Practice Address - Country:US
Practice Address - Phone:844-391-7277
Practice Address - Fax:512-857-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty