Provider Demographics
NPI:1306251541
Name:SELECTIVE MEDICAL STAFFING OF TEXAS LLC
Entity type:Organization
Organization Name:SELECTIVE MEDICAL STAFFING OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-647-4512
Mailing Address - Street 1:3330 MATLOCK RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2917
Mailing Address - Country:US
Mailing Address - Phone:903-647-4512
Mailing Address - Fax:877-753-9230
Practice Address - Street 1:3330 MATLOCK RD
Practice Address - Street 2:SUITE 207
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2917
Practice Address - Country:US
Practice Address - Phone:903-647-4512
Practice Address - Fax:877-753-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management