Healthcare Provider Details

I. General information

NPI: 1114742772
Provider Name (Legal Business Name): OMEGA HEIGHTS FAMILY MEDICINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 FLORIDA DR STE 121
ARLINGTON TX
76015-2380
US

IV. Provider business mailing address

2745 VIRGINIA PKWY STE 100
MCKINNEY TX
75071-4915
US

V. Phone/Fax

Practice location:
  • Phone: 214-491-4900
  • Fax: 214-491-4966
Mailing address:
  • Phone: 214-491-4900
  • Fax: 214-491-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NANETTE ICHO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 504-453-0873