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PROMED MANAGEMENT SERVICES ORGANIZATION, LP
Complete NPI Record 1386575728
Clinic/Center - Primary Care in Arlington, TX

NPI Status: Active since May 26, 2026

Contact Information

4201 INTERWAY PL
ARLINGTON, TX
ZIP 76018
Phone: (817) 438-6776
Fax: (469) 663-5516

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Complete NPI Dataset

This directory record outlines the complete schema field listings, logged data values, and structural definitions for PROMED MANAGEMENT SERVICES ORGANIZATION, LP (NPI: 1386575728), practicing as a certified clinic/center specialist with primary operations located in Arlington, TX. The dataset listed below details the current information logged inside the National Plan and Provider Enumeration System (NPPES) registry database for this specific individual assignment. Please use the integrated filtering tools directly below to separate properties by functional clinical categories, perform live keyword lookups, or jump immediately to a single tracking attribute line item.

Registry File Document Utilities
NPI: 1386575728
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: PROMED MANAGEMENT SERVICES ORGANIZATION, LP
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 4201 INTERWAY PL
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: ARLINGTON
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: TX
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 760185668
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 8174386776
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 4696635516
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 4201 INTERWAY PL
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: ARLINGTON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: TX
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 760185668
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8174386776
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4696635516
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/26/2026
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 5/26/2026
The date that a record was last updated or changed.
Authorized Official Last Name: DEMYUN
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MARC
The first name of the authorized official.
Authorized Official Title or Position: MEDICAL DIRECTOR
The title or position of the authorized official.
Authorized Official Telephone Number: 5706903451
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QP2300X
This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Is Organization Subpart: N
Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Authorized Official Credential Text: MD
The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
NPI Certification Date: 5/26/2026
The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.
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