Provider Demographics
NPI:1588266647
Name:CONNECT HEALTH CLINIC LLC
Entity type:Organization
Organization Name:CONNECT HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARACK
Authorized Official - Middle Name:
Authorized Official - Last Name:OTIENO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:817-808-7230
Mailing Address - Street 1:1108 W PIONEER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-7627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1108 W PIONEER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-7627
Practice Address - Country:US
Practice Address - Phone:682-252-4051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty