Provider Demographics
NPI:1982737714
Name:FAMILY HEALTH OF GRAPEVINE, PA
Entity Type:Organization
Organization Name:FAMILY HEALTH OF GRAPEVINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-329-9176
Mailing Address - Street 1:2321 IRA E WOODS AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8632
Mailing Address - Country:US
Mailing Address - Phone:817-329-9176
Mailing Address - Fax:817-329-9716
Practice Address - Street 1:2321 IRA E WOODS AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8632
Practice Address - Country:US
Practice Address - Phone:817-329-9176
Practice Address - Fax:817-329-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003EVOtherBCBS GROUP NUMBER
TX00211RMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TXF72093Medicare UPIN