Basic Information
| Provider Information | |||||||||
| NPI: | 1689288342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTEX MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5999 CUSTER RD # 110-523 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750359302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723304264 | ||||||||
| FaxNumber: | 9728507352 | ||||||||
| Practice Location | |||||||||
| Address1: | 981 STATE HIGHWAY 121 STE 4150 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723304264 | ||||||||
| FaxNumber: | 9728507352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2020 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | WOJNICKI | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING EMPLOYEE | ||||||||
| AuthorizedOfficialTelephone: | 9723304264 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.