Basic Information
| Provider Information | |||||||||
| NPI: | 1538386446 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JENNIFER HEATH MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2710 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750198710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722589750 | ||||||||
| FaxNumber: | 9722589569 | ||||||||
| Practice Location | |||||||||
| Address1: | 6410 SOUTHWEST BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | BENBROOK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761093918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177351888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 08/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | BILLMAN | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLAIMS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9722589570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | J6998 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0098BW | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 113817401 | 05 | TX | MEDICAID | 260035942 | 01 | TX | MEDICARE RAILROAD | OTHER |