Organization
FAMILY MEDICINE AT WILLOW BEND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY TICKLE KOMENDA (OFFICE MANAGER)
(972) 608-1868
Entity
Organization
Contact information
Practice address
5944 W PARKER RD STE 100, PLANO, TX 75093-6422
(972) 608-1868
(972) 943-8644
Mailing address
5944 W PARKER RD STE 100, PLANO, TX 75093-6422
(972) 608-1868
(972) 943-8644
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
H6350
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10018514
AMERIGROUP PROVIDER #
TX
05
—
165802301
—
TX
05
—
65802302
—
TX
Enumeration date
06/07/2007
Last updated
08/12/2008
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