Basic Information
| Provider Information | |||||||||
| NPI: | 1548489222 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS MEDICAL GROUP, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HEALTHCORE PHYSICIAN'S GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 678513 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752678513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727925700 | ||||||||
| FaxNumber: | 9727884707 | ||||||||
| Practice Location | |||||||||
| Address1: | 8210 WALNUT HILL LN | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722847000 | ||||||||
| FaxNumber: | 9722847001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 01/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | CARY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIANS | ||||||||
| AuthorizedOfficialTelephone: | 9722847000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 193777301 | 05 | TX | MEDICAID | DN5025 | 01 | TX | MEDICARE RAILROAD | OTHER | 0055PV | 01 | TX | BCBS | OTHER |