Basic Information
| Provider Information | |||||||||
| NPI: | 1043753924 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MYCAP CONSULTANTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 167704 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750167704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885512288 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Practice Location | |||||||||
| Address1: | 5550 LBJ FWY | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752406217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885512288 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2016 | ||||||||
| LastUpdateDate: | 11/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | HOOVER | ||||||||
| AuthorizedOfficialFirstName: | LANCE | ||||||||
| AuthorizedOfficialMiddleName: | MILTON | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2107374406 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | K3753 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.