Provider Demographics
NPI:1528011814
Name:PHYSICIANS AND ALLIED HEALTH PROFESSIONALS GROUP, PA
Entity Type:Organization
Organization Name:PHYSICIANS AND ALLIED HEALTH PROFESSIONALS GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEIGHTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-739-3001
Mailing Address - Street 1:12700 PARK CENTRAL DR
Mailing Address - Street 2:STE 900
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1500
Mailing Address - Country:US
Mailing Address - Phone:214-860-6053
Mailing Address - Fax:469-854-0738
Practice Address - Street 1:12700 PARK CENTRAL DR
Practice Address - Street 2:STE 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1500
Practice Address - Country:US
Practice Address - Phone:214-860-6053
Practice Address - Fax:469-854-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046AZOtherBCBS
OK200016270AMedicaid
TX109379103Medicaid
TX109379104Medicaid
NM79506232Medicaid
OK200016270AMedicaid
TXCN8341Medicare PIN
TXCG3777Medicare PIN
NM79506232Medicaid
TXDC1661Medicare PIN
TXDD8886Medicare PIN
TXCD7134Medicare PIN
TXDB5501Medicare PIN
TXDE3693Medicare PIN
TXCG4470Medicare PIN
TXDD1816Medicare PIN