Basic Information
| Provider Information | |||||||||
| NPI: | 1669827424 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEDSPRING OF TEXAS PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDPSRING URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3711 S. MOPAC EXPRESSWAY | ||||||||
| Address2: | BLDG. 2 STE 400 | ||||||||
| City: | AUST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787468014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889800505 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2501 WEST 7TH STREET | ||||||||
| Address2: | STE. 101 | ||||||||
| City: | FORT. WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761078013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889800505 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 04/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | BELSHER | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CMO | ||||||||
| AuthorizedOfficialTelephone: | 8889800505 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.