Provider Demographics
NPI:1124436167
Name:HERITAGE HEALTH CONCEPTS LLC
Entity type:Organization
Organization Name:HERITAGE HEALTH CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-580-7770
Mailing Address - Street 1:6025 COMMERCE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2642
Mailing Address - Country:US
Mailing Address - Phone:972-580-7770
Mailing Address - Fax:972-364-1269
Practice Address - Street 1:6025 COMMERCE DR
Practice Address - Street 2:SUITE 500
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2642
Practice Address - Country:US
Practice Address - Phone:972-580-7770
Practice Address - Fax:972-364-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1090284OtherCLIA