Modoma Medmassage, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MODOMA MEDMASSAGE, LLC

Practice address

4944 Preston Rd
Ste 100a
Frisco, TX 75034-8597

Phone

(469) 213-2762

NPI assigned

Oct 10, 2013

Last updated

Feb 13, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Dakota Black Hawke

Title

Director of Operations & Finance

Phone

(469) 213-2762

Specialties & licenses 1

Addresses

Tax ID family

Modoma3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• The Knead Physical Medicine P.a.

  dba Modoma

  • Family Medicine Physician
  • Coppell, TX
  • NPI 1710427059
  NPD tax ID
• The Knead Physical Medicine, PA

  • Massage Therapist
  • Farmers Branch, TX
  • NPI 1174062608
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486944000000",
    "number": "1508293382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4944 PRESTON RD",
            "address_2": "STE 100A",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750348597",
            "telephone_number": "469-213-2762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4944 PRESTON RD",
            "address_2": "STE 100A",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750348597",
            "telephone_number": "469-213-2762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODOMA MEDMASSAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-10",
        "last_updated": "2017-02-13",
        "status": "A",
        "authorized_official_last_name": "BLACK HAWKE",
        "authorized_official_first_name": "DAKOTA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS & FINANCE",
        "authorized_official_telephone_number": "469-213-2762",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Frisco, TX
• Providers in Frisco, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.