NPIMap

Organization Active NPI

The Colony Total Wellness Clinic, PLLC

  • Adult Medicine Physician
  • The Colony, TX
National Provider Identifier
1669977831
Registry record updated Mar 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
THE COLONY TOTAL WELLNESS CLINIC, PLLC
Practice address
4815 SH 121 Ste 5
The Colony, TX 75056-2906
Phone
(800) 246-5698
NPI assigned
Mar 28, 2018
Last updated
Mar 28, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
MODERN MALE T-CLINIC, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2018

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

Authorized official

Name
Salvatore Campo, DO
Title
DO/Physician
Phone
(800) 246-5698

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Adult Medicine Physician 207QA0505X Primary

Addresses

Primary practice location

4815 SH 121 Ste 5
The Colony, TX 75056-2906

Mailing address

5000 Eldorado Pkwy Ste 150-153
Frisco, TX 75033-8695

National Provider Directory

National Provider Directory
Part of
Modern Male T-Clinic PA

Locations

4815 Sh 121
Ste 5
The Colony, TX 75056

4815 State Highway 121
Ste 4
The Colony, TX 75056

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522195200000",
    "number": "1669977831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 ELDORADO PKWY STE 150-153",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750338695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4815 SH 121 STE 5",
            "city": "THE COLONY",
            "state": "TX",
            "postal_code": "750562906",
            "telephone_number": "800-246-5698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COLONY TOTAL WELLNESS CLINIC, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MODERN MALE T-CLINIC, P.A.",
        "enumeration_date": "2018-03-28",
        "last_updated": "2018-03-28",
        "status": "A",
        "authorized_official_last_name": "CAMPO",
        "authorized_official_first_name": "SALVATORE",
        "authorized_official_title_or_position": "DO/PHYSICIAN",
        "authorized_official_telephone_number": "800-246-5698",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in The Colony, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; 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.