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281 W Southlake Blvd Southlake TX 76092-7052 | |
| (469) 200-4093 | |
| (469) 200-4079 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 281 W Southlake Blvd, Southlake, Texas |
| Authorized Official Name and Position | Nazimuddin Mohammed (CEO) |
| Authorized Official Contact | 2177503053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
281 W Southlake Blvd Southlake TX 76092-7052 Ph: (469) 200-4093 | 281 W Southlake Blvd Southlake TX 76092-7052 Ph: (469) 200-4093 |
| NPI Number | 1295561801 |
|---|---|
| Provider Enumeration Date | 09/10/2024 |
| Last Update Date | 11/18/2024 |
| Certification Date | 11/18/2024 |
| Medicare PECOS PAC ID | 0749716942 |
|---|---|
| Medicare Enrollment ID | O20241211003032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295561801 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Nazimuddin T Mohammed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316974249 PECOS PAC ID: 4284684663 Enrollment ID: I20180220001277 |
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