Provider Demographics
NPI:1679921829
Name:CITYWIDE ACCREDITED INC.
Entity type:Organization
Organization Name:CITYWIDE ACCREDITED INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHON
Authorized Official - Middle Name:D
Authorized Official - Last Name:OREAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-300-8703
Mailing Address - Street 1:4287 BELT LINE RD
Mailing Address - Street 2:248
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4510
Mailing Address - Country:US
Mailing Address - Phone:214-300-8703
Mailing Address - Fax:
Practice Address - Street 1:4287 BELT LINE RD
Practice Address - Street 2:248
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4510
Practice Address - Country:US
Practice Address - Phone:214-300-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-28
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty