Provider Demographics
NPI:1083624571
Name:PRESTON MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:PRESTON MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:ELIAS
Authorized Official - Last Name:CHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-633-9700
Mailing Address - Street 1:3211 INTERNET BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1944
Mailing Address - Country:US
Mailing Address - Phone:469-633-9700
Mailing Address - Fax:469-633-9701
Practice Address - Street 1:3211 INTERNET BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1944
Practice Address - Country:US
Practice Address - Phone:469-633-9700
Practice Address - Fax:469-633-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5000OtherBLUE CROSS PROVIDER #
TX0072HDOtherBLUE CROSS GROUP #
TX8F5000OtherBLUE CROSS PROVIDER #