FAMILY MEDICINE AT WILLOW BEND NPI 1174726061

NPI Information

NPI: 1174726061
Provider Name: FAMILY MEDICINE AT WILLOW BEND
Classification: Clinic/Center - 261QH0100X
Entity Type: Organization

Specialization: Health Service

CLIA Number: 45D0907722

Address:
5944 W PARKER RD STE 100
PLANO, TX
ZIP 75093
Phone: (972) 608-1868
Get Directions

FAMILY MEDICINE AT WILLOW BEND is a health service clinic center in Plano, TX. FAMILY MEDICINE AT WILLOW BEND NPI is 1174726061. The provider is registered as an organization entity type.

The provider's business location address is:

5944 W PARKER RD STE 100
PLANO, TX
ZIP 75093-422
Phone: (972) 608-1868
Fax: (972) 943-8644

The provider's authorized official is Tammy Tickle Komenda .
The authorized official title is Office Manager and has the following contact phone number (972) 608-1868.

The CLIA number assigned to this NPI record is 45D0907722 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/7/2007 and was last updated on 8/12/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service	H6350	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	165802301	MEDICAID	TEXAS
2	65802302	MEDICAID	TEXAS
3	00964W	MEDICARE ID-TYPE UNSPECIFIED	TEXAS	ONE OF 2 MEDICARE #'S
4	E21206	MEDICARE UPIN	TEXAS
5	8C0534	MEDICARE ID-TYPE UNSPECIFIED	TEXAS	2 OF 2 MEDICARE #'S
6	10018514	OTHER	TEXAS	AMERIGROUP PROVIDER #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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