1588938187 NPI number — DFW PRACTICE CONSULTANTS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588938187 NPI number — DFW PRACTICE CONSULTANTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DFW PRACTICE CONSULTANTS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COVENANT MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588938187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 640
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76102-5304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-224-2292
Provider Business Mailing Address Fax Number:
866-279-9993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2705 HOSPITAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75051-0928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-224-2292
Provider Business Practice Location Address Fax Number:
866-279-9993
Provider Enumeration Date:
02/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
817-224-2292

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  N6605 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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