IDH MEDICAL PRACTICE, P.A.


Address: 6363 N State Highway 161 Ste 310, Irving, TX 75038-2262
Phone: 2142773969

IDH MEDICAL PRACTICE, P.A. (NPI# 1558851238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1558851238
Entity Type Organization
Organization Name IDH MEDICAL PRACTICE, P.A.
Other Organization Name IESO DIGITAL HEALTH
Practice Address 6363 N State Highway 161 Ste 310
Irving
TX 75038-2262
Practice Telephone 2142773969
Mailing Telephone 2142773969
Enumeration Date 2018-05-17
Last Update Date 2018-05-17
Authorized Official Name MR. JOHN TUCKER JR. (DIRECTOR OF OPERATIONS)
Authorized Official Telephone 2142773969
Authorized Official Credential MS
Is Organization Subpart Y
Parent Organization Name IESO DIGITAL HEALTH

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TB0200X Psychologist
Specialization: Cognitive & Behavioral
Behavioral Health & Social Service Providers

Other Provider/Organization Names

Other Name Type Code
Ieso Digital Health Other Name - Individual/Organization

Other Data Sources

Entity Type Entity Name Entity Address
Colorado Business Entities IDH MEDICAL PRACTICE, PA 6363 North State Highway 161, Suite 310, Irvine, TX 75038

Office Location

Street Address 6363 N STATE HIGHWAY 161 STE 310
City IRVING
State TX
Zip Code 75038-2262

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Taxonomy Information

Taxonomy Code 103TB0200X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Cognitive & Behavioral

Taxonomy Definition

Definition to come...
Notes: [1/1/2007: title modified]

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NPI Name Taxonomy Address Enumeration
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NPI Name Taxonomy Address Enumeration
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1982268595 Lyn George Mcdonald Psychologist 107 Crescent St, San Antonio, TX 78209-5219 2019-04-29
1326501594 Angela Paola Martinez Psychologist 2825 Wilcrest Dr Ste 128, Houston, TX 77042-3391 2019-04-12
1265947261 Brendon Gael Roatch-cardenas Psychologist 2175 Winrock Blvd, Houston, TX 77057-4000 2017-12-13
1376058115 Brain Changers, LLC Psychologist 6222 De Zavala Rd Ste 203, San Antonio, TX 78249-2291 2017-12-01
1609304518 Dawn Elizabeth Chandler Psychologist 1652 Prescott Cir, Flower Mound, TX 75028-7305 2017-05-23
1770010290 Julie Chambers Psychologist 3550 Parkwood Blvd Ste 304, Frisco, TX 75034-1905 2017-05-15
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1184035412 Evelyn Jagpat-o'halloran Psychologist 12028 Pepperidge Dr, Austin, TX 78739-1948 2014-05-08
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Competitor

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City IRVING
Zip Code 75038

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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