Provider Demographics
NPI:1447386966
Name:COPPELL ASSOCIATES IN FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:COPPELL ASSOCIATES IN FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-393-5559
Mailing Address - Street 1:848 S DENTON TAP RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4558
Mailing Address - Country:US
Mailing Address - Phone:972-393-5559
Mailing Address - Fax:972-393-5479
Practice Address - Street 1:848 S DENTON TAP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4558
Practice Address - Country:US
Practice Address - Phone:972-393-5559
Practice Address - Fax:972-393-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6149207Q00000X
TXPA02895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B19732Medicare UPIN