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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 0046AZ | Other | BCBS |
OK | 200016270A | Medicaid | |
TX | 109379103 | Medicaid | |
TX | 109379104 | Medicaid | |
NM | 79506232 | Medicaid | |
OK | 200016270A | Medicaid | |
TX | CN8341 | Medicare PIN | |
TX | CG3777 | Medicare PIN | |
NM | 79506232 | Medicaid | |
TX | DC1661 | Medicare PIN | |
TX | DD8886 | Medicare PIN | |
TX | CD7134 | Medicare PIN | |
TX | DB5501 | Medicare PIN | |
TX | DE3693 | Medicare PIN | |
TX | CG4470 | Medicare PIN | |
TX | DD1816 | Medicare PIN |