Basic Information
| Provider Information | |||||||||
| NPI: | 1467413625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHCARE ASSOCIATES OF IRVING PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 224968 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752224968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722587499 | ||||||||
| FaxNumber: | 9722558922 | ||||||||
| Practice Location | |||||||||
| Address1: | 6161 N STATE HIGHWAY 161 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750382220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722587499 | ||||||||
| FaxNumber: | 9722558922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | POWELL | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4692763600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 081036801 | 05 | TX | MEDICAID |