Provider Demographics
NPI:1780134122
Name:TEAXAS MEDICAL RESULTS, LLC
Entity type:Organization
Organization Name:TEAXAS MEDICAL RESULTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:972-494-3100
Mailing Address - Street 1:5500 DEMOCRACY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4202
Mailing Address - Country:US
Mailing Address - Phone:214-440-3007
Mailing Address - Fax:972-608-0005
Practice Address - Street 1:1708 COIT RD STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6198
Practice Address - Country:US
Practice Address - Phone:214-440-3007
Practice Address - Fax:972-608-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty