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3200 Southern Dr #107 Garland TX 75043-1549 | |
| (972) 278-5385 | |
| (972) 692-8687 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3200 Southern Dr, Garland, Texas |
| Authorized Official Name and Position | Jill W Bracken (PHYSICIAN) |
| Authorized Official Contact | 9722785385 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3200 Southern Dr #107 Garland TX 75043-1549 Ph: (972) 278-5385 | 3200 Southern Dr #107 Garland TX 75043-1549 Ph: (972) 278-5385 |
| NPI Number | 1316160807 |
|---|---|
| Provider Enumeration Date | 04/11/2007 |
| Last Update Date | 03/03/2015 |
| Medicare PECOS PAC ID | 2365474426 |
|---|---|
| Medicare Enrollment ID | O20050909000179 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316160807 | NPI | - | NPPES |
| 113612904 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | K6992 (Texas) | Primary |
| Provider Name | Jill W. Bracken |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710053319 PECOS PAC ID: 0446282503 Enrollment ID: I20050909000200 |
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