Basic Information
| Provider Information | |||||||||
| NPI: | 1750704441 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCENTURE MEDICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2033 W MCDERMOTT DR | ||||||||
| Address2: | SUITE 320 # 168 | ||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750134694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694262500 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 W LAMBERTH RD | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750922671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723859898 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2014 | ||||||||
| LastUpdateDate: | 01/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | VATTAM | ||||||||
| AuthorizedOfficialFirstName: | SREENADHA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4694262500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | M2851 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.