Provider Demographics
NPI:1003212440
Name:OMEGA HEIGHTS FAMILY MEDICINE CLINIC PLLC
Entity Type:Organization
Organization Name:OMEGA HEIGHTS FAMILY MEDICINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ICHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-491-4900
Mailing Address - Street 1:2730 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5088
Mailing Address - Country:US
Mailing Address - Phone:214-491-4900
Mailing Address - Fax:214-491-4966
Practice Address - Street 1:2730 VIRGINIA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5088
Practice Address - Country:US
Practice Address - Phone:214-491-4900
Practice Address - Fax:214-491-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X, 207QA0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty