Provider Demographics
NPI:1760004188
Name:IMPACT HEALTH DIRECT PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:IMPACT HEALTH DIRECT PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SJOGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-846-4800
Mailing Address - Street 1:1905 W ENNIS AVE STE 504B
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-3630
Mailing Address - Country:US
Mailing Address - Phone:972-846-4800
Mailing Address - Fax:410-237-6747
Practice Address - Street 1:1905 W ENNIS AVE STE 504B
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-3630
Practice Address - Country:US
Practice Address - Phone:972-846-4800
Practice Address - Fax:410-237-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care