Provider Demographics
NPI:1821835323
Name:THETA CARE PLLC
Entity type:Organization
Organization Name:THETA CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-318-9731
Mailing Address - Street 1:2410 LUNA RD STE 248
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6578
Mailing Address - Country:US
Mailing Address - Phone:972-318-9731
Mailing Address - Fax:877-360-0326
Practice Address - Street 1:2410 LUNA RD STE 252
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6538
Practice Address - Country:US
Practice Address - Phone:972-318-9731
Practice Address - Fax:877-360-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty
No251J00000XAgenciesNursing Care