Provider Demographics
NPI:1124840244
Name:LOCKHART MATTER MOHS & SURGERY CENTER
Entity type:Organization
Organization Name:LOCKHART MATTER MOHS & SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-553-1030
Mailing Address - Street 1:5805 COIT ROAD
Mailing Address - Street 2:STE 203
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6990
Mailing Address - Country:US
Mailing Address - Phone:469-553-1030
Mailing Address - Fax:469-485-1030
Practice Address - Street 1:5805 COIT RD STE 202
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6990
Practice Address - Country:US
Practice Address - Phone:469-769-3376
Practice Address - Fax:469-389-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty