Healthcare Provider Details

I. General information

NPI: 1003212440
Provider Name (Legal Business Name): OMEGA HEIGHTS FAMILY MEDICINE CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 VIRGINIA PKWY SUITE 200
MCKINNEY TX
75071-5088
US

IV. Provider business mailing address

2730 VIRGINIA PKWY SUITE 200
MCKINNEY TX
75071-5088
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 TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: NANETTE ICHO
Title or Position: PRESIDENT
Credential: MD
Phone: 214-491-4900