Provider Demographics
NPI:1972788628
Name:JEFFREY C. KOMENDA, M.D., P.A.
Entity Type:Organization
Organization Name:JEFFREY C. KOMENDA, M.D., P.A.
Other - Org Name:BEST CHOICE MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:TICKLE
Authorized Official - Last Name:KOMENDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-608-1868
Mailing Address - Street 1:5944 W PARKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6422
Mailing Address - Country:US
Mailing Address - Phone:972-608-1868
Mailing Address - Fax:972-943-8644
Practice Address - Street 1:1305 S SH 121
Practice Address - Street 2:STE C-108
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-5915
Practice Address - Country:US
Practice Address - Phone:972-608-1868
Practice Address - Fax:972-943-8644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY C. KOMENDA, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-31
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6350261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165802301Medicaid
TX165802302OtherMEDICAID HEALTH STEPS
TX10018514OtherAMERIGROUP
TX8AJ618OtherBC/BS INDIVIDUAL
TX0007QNOtherBC/BS GROUP NUMBER
TX165802302OtherMEDICAID HEALTH STEPS
TX00964WMedicare PIN