Provider Demographics
NPI:1578049052
Name:CONCEPTIVE CARE
Entity Type:Organization
Organization Name:CONCEPTIVE CARE
Other - Org Name:CCRM DALLAS-FORT WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORHASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-377-2625
Mailing Address - Street 1:8380 WARREN PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4199
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8380 WARREN PKWY STE 201
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4199
Practice Address - Country:US
Practice Address - Phone:972-377-2625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
No261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility FacilityGroup - Single Specialty