Basic Information
| Provider Information | |||||||||
| NPI: | 1275931545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEASONS MEDICAL GROUP OF TEXAS, PLLC | ||||||||
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| Address1: | 6400 SHAFER CT | ||||||||
| Address2: | STE 700 | ||||||||
| City: | ROSEMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600184914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476921000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1643 LANCASTER DR | ||||||||
| Address2: | STE 203 | ||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760513593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476921000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2014 | ||||||||
| LastUpdateDate: | 03/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | BILL | ||||||||
| AuthorizedOfficialFirstName: | CARRIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8476921148 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.