=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073624136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF COLLIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 12/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 N MCDONALD ST SUITE 130
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-2141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-548-5503
-----------------------------------------------------
Fax | 972-548-4441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 825 N MCDONALD ST SUITE 130
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-2141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-548-5503
-----------------------------------------------------
Fax | 972-548-4441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH CARE ADMINISTRATOR
-----------------------------------------------------
Name | MRS. CANDY BLAIR
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 972-548-5504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------