Provider Demographics
NPI:1871158162
Name:INFINIT MEN'S HEALTH CLINIC
Entity type:Organization
Organization Name:INFINIT MEN'S HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:MCKENZIE
Authorized Official - Last Name:KELLEHER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:405-550-4924
Mailing Address - Street 1:10108 HUNTERSVILLE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-2062
Mailing Address - Country:US
Mailing Address - Phone:405-550-4924
Mailing Address - Fax:
Practice Address - Street 1:279 W HIDDEN CREEK PKWY STE 1209
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-339-6252
Practice Address - Fax:817-662-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty