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401 W Campbell Rd Richardson TX 75080-3416 | |
| (972) 498-4000 | |
| (972) 498-4883 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 401 W Campbell Rd, Richardson, Texas |
| Authorized Official Name and Position | Craig Allen Bjerke (EXECUTIVE VP & CFO) |
| Authorized Official Contact | 2149474512 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 911875 Dallas TX 75391-1875 Ph: (469) 204-6900 | 401 W Campbell Rd Richardson TX 75080-3416 Ph: (972) 498-4000 |
| NPI Number | 1811142359 |
|---|---|
| Provider Enumeration Date | 11/25/2008 |
| Last Update Date | 06/08/2023 |
| Certification Date | 06/08/2023 |
| Medicare PECOS PAC ID | 5294646451 |
|---|---|
| Medicare Enrollment ID | O20111019000949 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811142359 | NPI | - | NPPES |
| 020921501 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 000549 (Texas) | Primary |
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