Provider Demographics
NPI:1699284737
Name:CUSTER MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:CUSTER MEDICAL CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BINI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:972-832-8784
Mailing Address - Street 1:8994 TOUR DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2036
Mailing Address - Country:US
Mailing Address - Phone:972-810-7070
Mailing Address - Fax:972-810-3221
Practice Address - Street 1:8994 TOUR DR STE 210
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2036
Practice Address - Country:US
Practice Address - Phone:972-810-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty