# EVOLVING MEDICAL INTEGRATION SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811513666
- **Authorized official:** CHANELLE BEVILACQUA (MANAGING MEMBER)
- **Authorized official phone:** (214) 475-1523

## Contact information

- **Practice address:** 5389 MONTEREY DR, FRISCO, TX 75034-4079
- **Practice address phone:** (214) 475-1523
- **Mailing address:** 5389 MONTEREY DR, FRISCO, TX 75034-4079
- **Mailing address phone:** (214) 475-1523

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |

## Other

- **Enumeration date:** 06/17/2020
- **Last updated:** 06/17/2020