Provider Demographics
NPI:1114489390
Name:TCERH PHYSICIANS PA
Entity Type:Organization
Organization Name:TCERH PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:BROWNFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-548-0351
Mailing Address - Street 1:4780 STATE HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2913
Mailing Address - Country:US
Mailing Address - Phone:214-548-0351
Mailing Address - Fax:
Practice Address - Street 1:4780 STATE HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2913
Practice Address - Country:US
Practice Address - Phone:214-548-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization