Provider Demographics
NPI:1821189945
Name:COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC
Entity Type:Organization
Organization Name:COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC
Other - Org Name:SOLIS WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:POLFREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-398-4110
Mailing Address - Street 1:15601 DALLAS PKWY
Mailing Address - Street 2:STE. 500
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3353
Mailing Address - Country:US
Mailing Address - Phone:469-398-4100
Mailing Address - Fax:469-398-4189
Practice Address - Street 1:3801 W 15TH ST STE C
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7775
Practice Address - Country:US
Practice Address - Phone:972-596-4033
Practice Address - Fax:972-985-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143932501Medicaid
TX143932501Medicaid
TX00393RMedicare PIN