Provider Demographics
NPI:1306395884
Name:AMBULATORY 22
Entity type:Organization
Organization Name:AMBULATORY 22
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-675-1881
Mailing Address - Street 1:5760 LEGACY DR STE B-325
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7102
Mailing Address - Country:US
Mailing Address - Phone:214-675-1881
Mailing Address - Fax:
Practice Address - Street 1:5760 LEGACY DR
Practice Address - Street 2:SUITE B-325
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7102
Practice Address - Country:US
Practice Address - Phone:214-787-3881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBULATORY 22
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center