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560 W Main St Ste. 101 Lewisville TX 75057-3629 | |
| (972) 221-1741 | |
| (972) 219-0057 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 560 W Main St, Lewisville, Texas |
| Authorized Official Name and Position | Debbie K. Johnson (OFFICE MANAGER) |
| Authorized Official Contact | 9722211741 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
560 W Main St Ste. 101 Lewisville TX 75057-3629 Ph: (972) 221-1741 | 560 W Main St Ste. 101 Lewisville TX 75057-3629 Ph: (972) 221-1741 |
| NPI Number | 1700901022 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 08/03/2011 |
| Medicare PECOS PAC ID | 1557381548 |
|---|---|
| Medicare Enrollment ID | O20051206000488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700901022 | NPI | - | NPPES |
| 220087501 | Medicaid | TX | |
| 0072MW | Other | TX | BLUE CROSS BLUE SHIELD |
| 200105540A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | F2490 (Texas) | Primary |
| Provider Name | Nishendu M Vasavada |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952473589 PECOS PAC ID: 2365462355 Enrollment ID: I20051206000807 |
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