Provider Demographics
NPI:1992354591
Name:NORTH TEXAS PRACTICE MANAGEMENT
Entity type:Organization
Organization Name:NORTH TEXAS PRACTICE MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-805-1886
Mailing Address - Street 1:7222 CRAWFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2672
Mailing Address - Country:US
Mailing Address - Phone:940-226-4850
Mailing Address - Fax:940-226-4855
Practice Address - Street 1:7222 CRAWFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-2672
Practice Address - Country:US
Practice Address - Phone:817-805-1886
Practice Address - Fax:940-226-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE