Provider Demographics
NPI:1750704441
Name:ACCENTURE MEDICAL SERVICES
Entity type:Organization
Organization Name:ACCENTURE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SREENADHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VATTAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-426-2500
Mailing Address - Street 1:2033 W MCDERMOTT DR
Mailing Address - Street 2:SUITE 320 # 168
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4694
Mailing Address - Country:US
Mailing Address - Phone:469-426-2500
Mailing Address - Fax:888-770-6360
Practice Address - Street 1:100 W LAMBERTH RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2671
Practice Address - Country:US
Practice Address - Phone:972-385-9898
Practice Address - Fax:888-770-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2851261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center