1407409311 NPI number — CONNECTIONS PRIMARY CARE FRISCO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407409311 NPI number — CONNECTIONS PRIMARY CARE FRISCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTIONS PRIMARY CARE FRISCO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407409311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 SHORELINE DR STE 151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76210-0176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-222-3152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 W LEBANON STE 124
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75036-3412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-222-3152
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GREGG
Authorized Official First Name:
LANDON
Authorized Official Middle Name:
AWSTIN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
469-222-3152

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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