Provider Demographics
NPI:1447880497
Name:MEDCARE-CTX-75069 PLLC
Entity type:Organization
Organization Name:MEDCARE-CTX-75069 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUPERROIR
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:972-375-6289
Mailing Address - Street 1:4300 SUNBELT DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5135
Mailing Address - Country:US
Mailing Address - Phone:972-375-6289
Mailing Address - Fax:
Practice Address - Street 1:1505 HARROUN AVE STE 1
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3433
Practice Address - Country:US
Practice Address - Phone:972-914-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty