Basic Information
| Provider Information | |||||||||
| NPI: | 1992342927 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN CLINICAL NETWORK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11816 INWOOD RD PMB 149 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727417189 | ||||||||
| FaxNumber: | 2146141448 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 REPUBLIC DR STE 500 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750748800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143907697 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2019 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | JENKINS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 9728276299 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.