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1700 N State Highway 360 Grand Prairie TX 75050-1926 | |
| (817) 381-0980 | |
| (817) 381-0986 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1700 N State Highway 360, Grand Prairie, Texas |
| Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | 1700 N State Highway 360 Grand Prairie TX 75050-1926 Ph: (817) 381-0980 |
| NPI Number | 1396226700 |
|---|---|
| Provider Enumeration Date | 08/23/2018 |
| Last Update Date | 08/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396226700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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