Provider Demographics
NPI:1407094543
Name:LAS COLINAS PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:LAS COLINAS PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-401-8726
Mailing Address - Street 1:215 S DENTON TAP RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3229
Mailing Address - Country:US
Mailing Address - Phone:972-906-9130
Mailing Address - Fax:
Practice Address - Street 1:215 S DENTON TAP RD
Practice Address - Street 2:SUITE 170
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3229
Practice Address - Country:US
Practice Address - Phone:972-906-9130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202722901Medicaid
TX0A3237Medicare PIN