Basic Information
| Provider Information | |||||||||
| NPI: | 1528397387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPTOWN INFUSION CENTER PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2929 CARLISLE ST | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752041084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143031033 | ||||||||
| FaxNumber: | 2143031032 | ||||||||
| Practice Location | |||||||||
| Address1: | 2929 CARLISLE ST | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752041084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143031033 | ||||||||
| FaxNumber: | 2143031032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2009 | ||||||||
| LastUpdateDate: | 12/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2143031033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QI0500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy |
No ID Information.