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General NPI Number Information
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NPI Number | 1639844954
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Entity Type | Organization
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Legal Business Name | IMMACULATE CONCEPTION HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 2105 W SPRING CREEK PKWY STE 320
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City | PLANO
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State | TX
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Zip | 75023-4566
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Country | US
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Telephone | 423-933-5223
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Fax | 682-270-0116
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Provider Business Mailing Address
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Address Line | 2105 W SPRING CREEK PKWY STE 320
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City | PLANO
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State | TX
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Zip | 75023-4566
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Country | US
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Telephone | 423-933-5223
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Fax | 682-270-0116
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Authorized Official
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Title or Position | OWNER
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Name | JAGRUTI RAJ
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Credential |
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Telephone | 423-933-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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