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General NPI Number Information
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NPI Number | 1114742772
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Entity Type | Organization
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Legal Business Name | OMEGA HEIGHTS FAMILY MEDICINE CLINIC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 1217 FLORIDA DR STE 121
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City | ARLINGTON
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State | TX
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Zip | 76015-2380
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Country | US
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Telephone | 214-491-4900
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Fax | 214-491-4966
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Provider Business Mailing Address
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Address Line | 2745 VIRGINIA PKWY STE 100
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City | MCKINNEY
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State | TX
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Zip | 75071-4915
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Country | US
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Telephone | 214-491-4900
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Fax | 214-491-4966
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. NANETTE ICHO
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Credential | MD
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Telephone | 504-453-0873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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