Provider Demographics
NPI:1275391260
Name:PHOENIX ONE HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:PHOENIX ONE HEALTH SOLUTIONS LLC
Other - Org Name:PHOENIX ONE HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-865-3570
Mailing Address - Street 1:1701 W NORTHWEST HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8145
Mailing Address - Country:US
Mailing Address - Phone:817-865-3570
Mailing Address - Fax:
Practice Address - Street 1:1701 W NORTHWEST HWY STE 100
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8145
Practice Address - Country:US
Practice Address - Phone:817-865-3570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty