Provider Demographics
NPI:1174962823
Name:OCCUMED PLUS-GRAND PRAIRIE
Entity type:Organization
Organization Name:OCCUMED PLUS-GRAND PRAIRIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMA/NCT
Authorized Official - Phone:817-984-9581
Mailing Address - Street 1:805 W. NORTH CARRIER PKWY
Mailing Address - Street 2:260
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050
Mailing Address - Country:US
Mailing Address - Phone:817-984-9580
Mailing Address - Fax:817-984-9581
Practice Address - Street 1:805 W. NORTH CARRIER PKWY
Practice Address - Street 2:260
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:817-984-9580
Practice Address - Fax:817-984-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty