Provider Demographics
NPI:1023684362
Name:STONEBRIDGE HEALTH PLLC
Entity type:Organization
Organization Name:STONEBRIDGE HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:OTEO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-563-1414
Mailing Address - Street 1:7204 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3498
Mailing Address - Country:US
Mailing Address - Phone:469-535-3800
Mailing Address - Fax:469-533-0399
Practice Address - Street 1:7204 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-3498
Practice Address - Country:US
Practice Address - Phone:469-535-3800
Practice Address - Fax:469-533-0399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONEBRIDGE HEALTH PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-27
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty