Provider Demographics
NPI:1790956464
Name:DCOA PHYSICIAN ASSOCIATES PA
Entity Type:Organization
Organization Name:DCOA PHYSICIAN ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-840-5245
Mailing Address - Street 1:3 RIVERWAY
Mailing Address - Street 2:SUITE 825
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1919
Mailing Address - Country:US
Mailing Address - Phone:713-840-5245
Mailing Address - Fax:281-897-9906
Practice Address - Street 1:NEC LITCHFIELD & MCDOWELL ROAD
Practice Address - Street 2:BUILDING A SUITE 104
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338
Practice Address - Country:US
Practice Address - Phone:832-237-3500
Practice Address - Fax:832-237-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DCOA PHYSICIAN ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-20
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty