| Clinical Neuroscience Pa | |
|
1307 8th Ave Ste 608 Fort Worth TX 76104-4140 | |
| (817) 921-4191 | |
| (817) 926-6048 |
| Full Name | Clinical Neuroscience Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1307 8th Ave Ste 608, Fort Worth, Texas |
| Authorized Official Name and Position | Teresa R Hernandez (ADMINISTRATOR) |
| Authorized Official Contact | 8179214191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinical Neuroscience Pa 1307 8th Ave Ste 608 Fort Worth TX 76104-4109 Ph: (817) 921-4191 | Clinical Neuroscience Pa 1307 8th Ave Ste 608 Fort Worth TX 76104-4140 Ph: (817) 921-4191 |
| NPI Number | 1760459671 |
|---|---|
| Provider Enumeration Date | 03/01/2006 |
| Last Update Date | 05/15/2023 |
| Certification Date | 05/15/2023 |
| Medicare PECOS PAC ID | 5991737926 |
|---|---|
| Medicare Enrollment ID | O20050909000770 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760459671 | NPI | - | NPPES |
| 112880305 | Medicaid | TX | |
| 112880306 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (Texas) | Primary |
| Provider Name | Charlece Lynn Hughes |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326039215 PECOS PAC ID: 5799702080 Enrollment ID: I20051026000562 |
| Provider Name | Victoria K Nwosu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558449603 PECOS PAC ID: 5597811406 Enrollment ID: I20121022000439 |
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