| Benbrook Neurology | |
|
5801 Oakbend Trl Ste 270 Fort Worth TX 76132-3922 | |
| (817) 615-9496 | |
| (855) 576-4158 |
| Full Name | Benbrook Neurology |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 10/29/2024 |
| Certification Date | 10/29/2024 |
| Medicare PECOS PAC ID | 2163432964 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134121940 PECOS PAC ID: 8325058126 Enrollment ID: I20111114000357 |
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