| Family Medicine At Willow Bend | |
|
5944 W Parker Rd Suite 100 Plano TX 75093-6421 | |
| (972) 608-1868 | |
| (972) 943-8644 |
| Full Name | Family Medicine At Willow Bend |
|---|---|
| Speciality | Clinic/Center |
| Location | 5944 W Parker Rd, Plano, Texas |
| Authorized Official Name and Position | Jeffrey Craig Komenda (MEDICAL DOCTOR) |
| Authorized Official Contact | 9726081868 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine At Willow Bend 5944 W Parker Rd Plano TX 75093-6422 Ph: (972) 608-1868 | Family Medicine At Willow Bend 5944 W Parker Rd Suite 100 Plano TX 75093-6421 Ph: (972) 608-1868 |
| NPI Number | 1003800434 |
|---|---|
| Provider Enumeration Date | 08/31/2005 |
| Last Update Date | 02/28/2012 |
| Medicare PECOS PAC ID | 4880664465 |
|---|---|
| Medicare Enrollment ID | O20040729001584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003800434 | NPI | - | NPPES |
| 124934405 | Medicaid | TX | |
| 165802302 | Medicaid | TX | |
| 10018514 | Other | TX | AMERIGROUP |
| 165802301 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | H6350 (Texas) | Primary |
| Provider Name | Jeffrey Craig Komenda |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396934865 PECOS PAC ID: 1153391735 Enrollment ID: I20040802001183 |
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