Benbrook Neurology | |
5801 Oakbend Trl Ste 270 Fort Worth TX 76132-3922 | |
(817) 615-9496 | |
(855) 576-4158 |
Full Name | Benbrook Neurology |
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Speciality | Psychiatry & Neurology |
Location | 5801 Oakbend Trl Ste 270, Fort Worth, Texas |
Authorized Official Name and Position | Edward Earl Icaza (PRESIDENT) |
Authorized Official Contact | 8176159496 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Benbrook Neurology 5801 Oakbend Trl Ste 270 Fort Worth TX 76132-3922 Ph: (817) 615-9496 | Benbrook Neurology 5801 Oakbend Trl Ste 270 Fort Worth TX 76132-3922 Ph: (817) 615-9496 |
NPI Number | 1033295142 |
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Provider Enumeration Date | 10/31/2006 |
Last Update Date | 10/29/2024 |
Certification Date | 10/29/2024 |
Medicare PECOS PAC ID | 2163432964 |
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Medicare Enrollment ID | O20060424000511 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033295142 | NPI | - | NPPES |
K9809 | Other | TX | NEUROLOGIST |
0072JA | Other | TX | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
2084N0400X | Psychiatry & Neurology - Neurology | K9809 (Texas) | Primary |
Provider Name | Edward Icaza |
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Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1134121940 PECOS PAC ID: 8325058126 Enrollment ID: I20111114000357 |
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