Provider Demographics
NPI:1679748834
Name:ELITE FAMILY HEALTH OF PLANO, PLLC
Entity Type:Organization
Organization Name:ELITE FAMILY HEALTH OF PLANO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:2595 DALLAS PKWY
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8527
Mailing Address - Country:US
Mailing Address - Phone:469-362-8282
Mailing Address - Fax:469-362-8283
Practice Address - Street 1:2595 DALLAS PKWY
Practice Address - Street 2:SUITE 403
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8527
Practice Address - Country:US
Practice Address - Phone:469-362-8282
Practice Address - Fax:469-362-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0061RLOtherBCBS
TX0061RLOtherBCBS