Organization
CCRM DFW, LLC
Active
Other names
CCRM Dallas Fort Worth
Organization subpart
No
Provider details
NPI number
Authorized official
JON PARDEW (CEO)
(303) 968-1950
Entity
Organization
Contact information
Practice address
8380 WARREN PKWY STE 201, FRISCO, TX 75034
(972) 377-2625
Mailing address
9380 STATION ST STE 425, LONE TREE, CO 80124-6832
(303) 968-1950
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
07/25/2018
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