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320 Custer Rd Richardson TX 75080-5623 | |
| (972) 490-9055 | |
| (972) 490-9058 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 320 Custer Rd, Richardson, Texas |
| Authorized Official Name and Position | Amy Spawn (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9724909055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
320 Custer Rd Richardson TX 75080-5623 Ph: (972) 490-9055 | 320 Custer Rd Richardson TX 75080-5623 Ph: (972) 490-9055 |
| NPI Number | 1538214200 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 02/25/2021 |
| Certification Date | 02/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538214200 | NPI | - | NPPES |
| 017436901 | Medicaid | TX | |
| 017436902 | Medicaid | TX |
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