Provider Demographics
NPI:1932374253
Name:ARLINGTON PRIMARY MEDICINE PLLC
Entity Type:Organization
Organization Name:ARLINGTON PRIMARY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-401-8726
Mailing Address - Street 1:920 HIGHWAY 287 N
Mailing Address - Street 2:STE 300
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2627
Mailing Address - Country:US
Mailing Address - Phone:817-539-0770
Mailing Address - Fax:817-539-0772
Practice Address - Street 1:920 HIGHWAY 287 N
Practice Address - Street 2:STE 300
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2627
Practice Address - Country:US
Practice Address - Phone:817-539-0770
Practice Address - Fax:817-539-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010RHOtherBLUE CROSS BLUE SHIELD
TX197911401Medicaid
TX197911401Medicaid