Provider Demographics
NPI:1427775451
Name:FULL LIFE PRIMARY CARE PLLC
Entity type:Organization
Organization Name:FULL LIFE PRIMARY CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEELU
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-207-4589
Mailing Address - Street 1:600 E TAYLOR ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2832
Mailing Address - Country:US
Mailing Address - Phone:903-257-3929
Mailing Address - Fax:903-827-4015
Practice Address - Street 1:600 E TAYLOR ST STE 201
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2832
Practice Address - Country:US
Practice Address - Phone:903-257-3929
Practice Address - Fax:903-827-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty