Provider Demographics
NPI:1831698976
Name:INDEPENDENT CLINICAL RESEARCH LLC
Entity type:Organization
Organization Name:INDEPENDENT CLINICAL RESEARCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-534-8460
Mailing Address - Street 1:PO BOX 2281
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0042
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:888-770-6360
Practice Address - Street 1:2600 W PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1114
Practice Address - Country:US
Practice Address - Phone:972-997-8000
Practice Address - Fax:972-437-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty