Individual ProviderJack Bridges BankheadInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address4708 Alliance Blvd Ste 300, Baylor Medical Plaza 1, Plano, TX 75093-5339(972) 758-6000PECOS EnrollmentBased on the most recent information from CMS, provider Jack Bridges Bankhead does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1619080728Provider TypeIndividualFull NameBankhead, Jack BridgesTitleDr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date8/16/2006Last Updated6/29/2008Contact InformationPractice LocationPractice Address4708 Alliance Blvd Ste 300, Baylor Medical Plaza 1, Plano, TX 75093-5339Phone(972) 758-6000Fax(972) 758-6001Mailing LocationMailing Address4708 Alliance Blvd Ste 300, Baylor Medical Plaza 1, Plano, TX 75093-5339Phone(972) 758-6000Fax(972) 758-6001Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseD6939TexasProvider IdentifiersIDDescriptionIssuerID110160026DescriptionOtherIssuerRR MEDICARETexasID1289126-06DescriptionMedicaidIssuerUnlistedTexasID128912604DescriptionMedicaidIssuerUnlistedTexas