Provider Demographics
NPI:1528291804
Name:SPAIN HEALTHCARE GROUP PA
Entity type:Organization
Organization Name:SPAIN HEALTHCARE GROUP PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-917-2156
Mailing Address - Street 1:5100 W ELDORADO PKWY
Mailing Address - Street 2:102-820
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6309
Mailing Address - Country:US
Mailing Address - Phone:972-483-0175
Mailing Address - Fax:800-299-5096
Practice Address - Street 1:7900 HENNEMAN WAY
Practice Address - Street 2:220
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2914
Practice Address - Country:US
Practice Address - Phone:972-268-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5381Medicare PIN