Basic Information
Provider Information | |||||||||
NPI: | 1578935953 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AMERICARE MEDICAL GROUP, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 15800 DOOLEY RD | ||||||||
Address2: | SUITE 185 | ||||||||
City: | ADDISON | ||||||||
State: | TX | ||||||||
PostalCode: | 750014284 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9726612273 | ||||||||
FaxNumber: | 8662926489 | ||||||||
Practice Location | |||||||||
Address1: | 15800 DOOLEY RD | ||||||||
Address2: | SUITE 185 | ||||||||
City: | ADDISON | ||||||||
State: | TX | ||||||||
PostalCode: | 750014284 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9726612273 | ||||||||
FaxNumber: | 8662926489 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/26/2015 | ||||||||
LastUpdateDate: | 10/26/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SWAYDEN | ||||||||
AuthorizedOfficialFirstName: | KELLY | ||||||||
AuthorizedOfficialMiddleName: | ROBERT | ||||||||
AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
AuthorizedOfficialTelephone: | 9726612273 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207X00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 364SA2100X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Acute Care | 207RI0200X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.