Basic Information
Provider Information
NPI: 1962691667
EntityType: 2
ReplacementNPI:  
OrganizationName: AMERICAN CURRENT CARE, P.A.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherNameSuffix:  
OtherCredential:  
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Mailing Information
Address1: 5080 SPECTRUM DRIVE
Address2: SUITE 1200 WEST
City: ADDISON
State: TX
PostalCode: 750014625
CountryCode: US
TelephoneNumber: 9723648000
FaxNumber: 2147754406
Practice Location
Address1: 4006 LIVE OAK
Address2:  
City: DALLAS
State: TX
PostalCode: 75204
CountryCode: US
TelephoneNumber: 2148216007
FaxNumber: 2148216149
Other Information
ProviderEnumerationDate: 10/18/2007
LastUpdateDate: 04/16/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FOGARTY
AuthorizedOfficialFirstName: W
AuthorizedOfficialMiddleName: TOM
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 9723648000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  N Ambulatory Health Care FacilitiesClinic/CenterUrgent Care
261Q00000X  Y Ambulatory Health Care FacilitiesClinic/Center 

No ID Information.


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