Provider Demographics
NPI:1033307020
Name:YOUR MEDICAL HOME, P.A.
Entity Type:Organization
Organization Name:YOUR MEDICAL HOME, P.A.
Other - Org Name:TEXAS MEDICAL HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-437-9090
Mailing Address - Street 1:101 S COIT RD
Mailing Address - Street 2:STE 317
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5743
Mailing Address - Country:US
Mailing Address - Phone:972-437-9090
Mailing Address - Fax:972-234-6474
Practice Address - Street 1:101 S COIT RD
Practice Address - Street 2:STE 317
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5743
Practice Address - Country:US
Practice Address - Phone:972-437-9090
Practice Address - Fax:972-234-6474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0009QQOtherBCBS
C12654OtherUPIN
TX00Z324Medicare PIN