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Organization
CCRM DFW, LLC
Active
Organization
CCRM DFW, LLC
Active
Other names
CCRM Dallas Fort Worth
Organization subpart
No
Provider details
NPI number
Authorized official
MATT TYSON (DIRECTOR, MANAGED CARE CONTRACTING)
(615) 477-6677
Entity
Organization
Contact information
Practice address
8380 WARREN PKWY STE 201, FRISCO, TX 75034
(972) 377-2625
Mailing address
8380 WARREN PKWY STE 201, FRISCO, TX 75034-4199
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130394
ASC LICENSE
—
01
—
45D1095599
CLIA
—
Enumeration date
07/20/2018
Last updated
07/10/2026
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