| Alice Place Medical Care Services | |
|
2719 La Jolla Blvd Grand Prairie TX 75054-0299 | |
| (469) 756-7021 | |
| (469) 502-3622 |
| Full Name | Alice Place Medical Care Services |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2719 La Jolla Blvd, Grand Prairie, Texas |
| Authorized Official Name and Position | Monnie E Adereti (CEO) |
| Authorized Official Contact | 4697567021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alice Place Medical Care Services 2719 La Jolla Blvd Grand Prairie TX 75054-0299 Ph: (469) 756-7021 | Alice Place Medical Care Services 2719 La Jolla Blvd Grand Prairie TX 75054-0299 Ph: (469) 756-7021 |
| NPI Number | 1710654900 |
|---|---|
| Provider Enumeration Date | 08/25/2021 |
| Last Update Date | 12/28/2021 |
| Certification Date | 12/28/2021 |
| Medicare PECOS PAC ID | 4789082819 |
|---|---|
| Medicare Enrollment ID | O20211005000023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710654900 | NPI | - | NPPES |
| 370763001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Monnie E Adereti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922498468 PECOS PAC ID: 7810264686 Enrollment ID: I20170526000305 |
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