Provider Demographics
NPI:1801104377
Name:MEDICAL HOUSECALLS OF DALLAS, LLC
Entity type:Organization
Organization Name:MEDICAL HOUSECALLS OF DALLAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ESPIRIDION
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPAS, PA-C
Authorized Official - Phone:214-385-4665
Mailing Address - Street 1:687 E ROYAL LN
Mailing Address - Street 2:2109
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3630
Mailing Address - Country:US
Mailing Address - Phone:214-385-4665
Mailing Address - Fax:972-499-0034
Practice Address - Street 1:687 E ROYAL LN
Practice Address - Street 2:2109
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3630
Practice Address - Country:US
Practice Address - Phone:214-385-4665
Practice Address - Fax:972-499-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05410261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center