Aeon Health, Inc.

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

H0463 Issued in TX

Legal business name

AEON HEALTH, INC.

Practice address

4809 Cole Ave Ste 110
Dallas, TX 75205-3553

Phone

(214) 526-8600

Fax

(214) 443-3897

NPI assigned

Apr 17, 2009

Last updated

Apr 17, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Irene Rae Willingham, M.D.NPI 1376570101

Title

Owner

Phone

(214) 526-8600

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Irene Rae Willingham, M.D.

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Dallas, TX
  • NPI 1376570101
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239926400000",
    "number": "1154564383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4809 COLE AVE STE 110",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752053553",
            "telephone_number": "214-526-8600",
            "fax_number": "214-443-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4809 COLE AVE STE 110",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752053553",
            "telephone_number": "214-526-8600",
            "fax_number": "214-443-3897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEON HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-17",
        "last_updated": "2009-04-17",
        "status": "A",
        "authorized_official_last_name": "WILLINGHAM",
        "authorized_official_first_name": "IRENE",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-526-8600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "TX",
            "license": "H0463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.