Provider Demographics
NPI:1407409311
Name:CONNECTIONS PRIMARY CARE FRISCO
Entity Type:Organization
Organization Name:CONNECTIONS PRIMARY CARE FRISCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:AWSTIN
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCDC
Authorized Official - Phone:469-222-3152
Mailing Address - Street 1:2701 SHORELINE DR STE 151
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0176
Mailing Address - Country:US
Mailing Address - Phone:469-222-3152
Mailing Address - Fax:
Practice Address - Street 1:255 W LEBANON STE 124
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-3412
Practice Address - Country:US
Practice Address - Phone:469-222-3152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty