Provider Demographics
NPI:1114144102
Name:MAD DOG ENTERPRISES LP
Entity type:Organization
Organization Name:MAD DOG ENTERPRISES LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:903-687-2500
Mailing Address - Street 1:390 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-9113
Mailing Address - Country:US
Mailing Address - Phone:903-687-2500
Mailing Address - Fax:
Practice Address - Street 1:390 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:WASKOM
Practice Address - State:TX
Practice Address - Zip Code:75692-9113
Practice Address - Country:US
Practice Address - Phone:903-687-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty