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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
MICHAEL W BUKOSKY (PRESIDENT PPM)
(972) 847-0712
Entity
Organization
Contact information
Practice address
2801 GATEWAY DRIVE, SUITE 100, IRVING, TX 75063-2694
(972) 847-0712
(817) 419-4605
Mailing address
PO BOX 678095, DALLAS, TX 75267-8095
(972) 847-0712
(817) 419-4605
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
133V00000X
Registered Dietitian
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VG0400X
Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0043AU
MEDICARE - DALLAS
TX
01
—
00R86C
MEDICARE - TARRANT
TX
01
—
00U61E
MEDICARE - OTHER
TX
05
—
313447001
—
TX
05
—
314681301
—
TX
05
—
314801701
—
TX
Enumeration date
10/31/2006
Last updated
06/21/2018
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