Provider Demographics
NPI:1417390188
Name:BDPM MCKINNEY, PLLC
Entity Type:Organization
Organization Name:BDPM MCKINNEY, PLLC
Other - Org Name:BLUE DIAMOND PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:972-542-5879
Mailing Address - Street 1:270 REDBUD BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3390
Mailing Address - Country:US
Mailing Address - Phone:972-542-5879
Mailing Address - Fax:972-542-7779
Practice Address - Street 1:270 REDBUD BLVD
Practice Address - Street 2:STE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3390
Practice Address - Country:US
Practice Address - Phone:972-542-5879
Practice Address - Fax:972-542-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6953350001OtherMEDICARE DMEPOS
TX319595Medicare PIN