Provider Demographics
NPI:1467077297
Name:YOUR DOCTOR'S OFFICE AT HOME LLC
Entity Type:Organization
Organization Name:YOUR DOCTOR'S OFFICE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-355-6519
Mailing Address - Street 1:3630 W PIONEER PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4534
Mailing Address - Country:US
Mailing Address - Phone:817-457-3200
Mailing Address - Fax:
Practice Address - Street 1:3630 W PIONEER PKWY STE 115
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4534
Practice Address - Country:US
Practice Address - Phone:817-457-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty