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Organization
MEDICAL CLINIC OF NORTH TEXAS, PLLC
Active
Organization
MEDICAL CLINIC OF NORTH TEXAS, PLLC
Active
Other names
USMD Physician Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL W BUKOSKY (PRESIDENT PPM)
(972) 847-0712
Entity
Organization
Contact information
Practice address
811 W. I-20, SUITE 120, ARLINGTON, TX 76017-2694
(972) 847-0712
(817) 419-4605
Mailing address
PO BOX 678095, DALLAS, TX 75267-8095
(972) 847-0712
(817) 514-5246
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RR0500X
Rheumatology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
208800000X
Urology Physician
—
—
213E00000X
Podiatrist
0926
TX
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R86C
MEDICARE GROUP NUMBER
TX
01
—
084933301
MEDICAID GROUP NUMBER
TX
01
—
CC7989
MEDICARE RAILROAD GROUP
TX
01
—
CD2314
MEDICARE RAILROAD GROUP
TX
01
—
CG2930
MEDICARE RAILROAD GROUP
TX
01
—
CU0775
MEDICARE RAILROAD GROUP
TX
Enumeration date
05/04/2006
Last updated
11/08/2016
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