| NPI | 1043703358 |
|---|---|
| Former Legal Business Name | PURPLE HEARTS PRIMARY CARE SERVICES |
| Entity Type | Organization |
| Authorized Contact | RAVEN MODISETTE CEO 817-969-4651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX AP137299) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2020-12-07 |