Provider Demographics
NPI:1982982195
Name:LONESTAR HOUSECALL PHYSICIANS PLLC
Entity Type:Organization
Organization Name:LONESTAR HOUSECALL PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:IDOWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-951-0009
Mailing Address - Street 1:8150 BROOKRIVER DR STE 303
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4055
Mailing Address - Country:US
Mailing Address - Phone:214-951-0009
Mailing Address - Fax:214-951-0060
Practice Address - Street 1:8150 BROOKRIVER DR STE 303
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4055
Practice Address - Country:US
Practice Address - Phone:214-951-0009
Practice Address - Fax:214-951-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK06009OtherLICENSE
TX111880404Medicaid
TXK06009OtherLICENSE