Provider Demographics
NPI:1114742772
Name:OMEGA HEIGHTS FAMILY MEDICINE CLINIC
Entity type:Organization
Organization Name:OMEGA HEIGHTS FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ICHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-453-0873
Mailing Address - Street 1:2745 VIRGINIA PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4915
Mailing Address - Country:US
Mailing Address - Phone:214-491-4900
Mailing Address - Fax:214-491-4966
Practice Address - Street 1:1217 FLORIDA DR STE 121
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2380
Practice Address - Country:US
Practice Address - Phone:214-491-4900
Practice Address - Fax:214-491-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty