Basic Information
| Provider Information | |||||||||
| NPI: | 1003523002 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IES CENTRAL TEXAS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4835 LBJ FWY STE 900 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752446001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277985450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 CIRCLE DR | ||||||||
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| City: | HILLSBORO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 766452670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545808500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZENAROSA | ||||||||
| AuthorizedOfficialFirstName: | NESTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER AO | ||||||||
| AuthorizedOfficialTelephone: | 4694205527 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.