Provider Demographics
NPI:1417673740
Name:PRIMARY ALTERNATIVES PLLC
Entity Type:Organization
Organization Name:PRIMARY ALTERNATIVES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-313-5597
Mailing Address - Street 1:1400 W NORTHWEST HWY STE 280
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8120
Mailing Address - Country:US
Mailing Address - Phone:817-313-5597
Mailing Address - Fax:
Practice Address - Street 1:15110 DALLAS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4601
Practice Address - Country:US
Practice Address - Phone:817-313-5597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty