Provider Demographics
NPI: | 1932273141 |
---|---|
Name: | MEDICAL & SURGICAL CLINIC OF IRVING, P.A. |
Entity Type: | Organization |
Organization Name: | MEDICAL & SURGICAL CLINIC OF IRVING, P.A. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LYNNE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOLLYFIELD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-253-4208 |
Mailing Address - Street 1: | 2021 N MACARTHUR BLVD |
Mailing Address - Street 2: | SUITE 150 |
Mailing Address - City: | IRVING |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75061-2219 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-253-4354 |
Mailing Address - Fax: | 972-253-4218 |
Practice Address - Street 1: | 2021 N MACARTHUR BLVD |
Practice Address - Street 2: | SUITE 150 |
Practice Address - City: | IRVING |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75061-2222 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-253-4354 |
Practice Address - Fax: | 972-253-4218 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-20 |
Last Update Date: | 2016-05-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 00T158 | Other | MEDICARE GROUP PTAN |
TX | 111962001 | Medicaid |