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MODERN MALE T-CLINIC P.A. NPI 1518389022


NPI Information

NPI: 1518389022
Provider Name: MODERN MALE T-CLINIC, P.A.
Classification: General Practice - 208D00000X
Entity Type: Organization

CLIA Number: 45D2071972

Address:
15340 DALLAS PKWY
STE2400
DALLAS, TX
ZIP 75248
Phone: (800) 246-5698
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MODERN MALE T-CLINIC, P.A. is a general practice in Dallas, TX. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee MODERN MALE T-CLINIC, P.A. NPI is 1518389022. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

15340 DALLAS PKWY
STE2400
DALLAS, TX
ZIP 75248-636
Phone: (800) 246-5698

The provider's authorized official is Salvatore Campo .
The authorized official title is Owner and has the following contact phone number (800) 246-5698.

The CLIA number assigned to this NPI record is 45D2071972 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 1/17/2014 and was last updated on 1/17/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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