| On Epiphany Lane, Llc | |
|
603 Munger Ave Ste 100 Dallas TX 75202-1840 | |
| (214) 560-0304 | |
| Not Available |
| Full Name | On Epiphany Lane, Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 603 Munger Ave Ste 100, Dallas, Texas |
| Authorized Official Name and Position | Tiffany Neulene Lindley (MANAGING MEMBER) |
| Authorized Official Contact | 2145600304 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| On Epiphany Lane, Llc 603 Munger Ave # 100-239 Dallas TX 75202-1839 Ph: (214) 560-0304 | On Epiphany Lane, Llc 603 Munger Ave Ste 100 Dallas TX 75202-1840 Ph: (214) 560-0304 |
| NPI Number | 1891396313 |
|---|---|
| Provider Enumeration Date | 11/02/2020 |
| Last Update Date | 11/02/2020 |
| Certification Date | 11/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891396313 | NPI | - | NPPES |
| 1215272737 | Other | TX | NPI |
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