| Oversite Neuro | |
|
14983 Boaz Ln Lindale TX 75771-4801 | |
| (972) 896-1843 | |
| (214) 919-2560 |
| Full Name | Oversite Neuro |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 14983 Boaz Ln, Lindale, Texas |
| Authorized Official Name and Position | Mary Jane Semich (OWNER/CEO) |
| Authorized Official Contact | 9728961843 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oversite Neuro 14983 Boaz Ln Lindale TX 75771-4801 Ph: (903) 530-6827 | Oversite Neuro 14983 Boaz Ln Lindale TX 75771-4801 Ph: (972) 896-1843 |
| NPI Number | 1629747753 |
|---|---|
| Provider Enumeration Date | 09/11/2021 |
| Last Update Date | 12/28/2022 |
| Certification Date | 12/28/2022 |
| Medicare PECOS PAC ID | 5890193114 |
|---|---|
| Medicare Enrollment ID | O20211018000269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629747753 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Primary |
| Provider Name | Thomas Alexander Mitchell |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1831128297 PECOS PAC ID: 3173594207 Enrollment ID: I20040803000997 |
| Provider Name | Badreldin Ibrahim |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1295726453 PECOS PAC ID: 7315997491 Enrollment ID: I20050310000063 |
| Provider Name | Saadat Ali Khan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1043371784 PECOS PAC ID: 6709982820 Enrollment ID: I20070507000562 |
| Provider Name | Igor Rakovchik |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1982868899 PECOS PAC ID: 3375673304 Enrollment ID: I20100617000294 |
| Provider Name | Kathy A Toler |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1639172208 PECOS PAC ID: 1456436823 Enrollment ID: I20100825000752 |
| Provider Name | Simon Sy Tan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811001365 PECOS PAC ID: 2567363187 Enrollment ID: I20101008000268 |
| Provider Name | Mark L Ritch |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1659313732 PECOS PAC ID: 8628049350 Enrollment ID: I20200128002067 |
| Provider Name | Julian A Bragg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164606018 PECOS PAC ID: 1951447382 Enrollment ID: I20230306000094 |
| Provider Name | Husham Mishu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1326022583 PECOS PAC ID: 1355235714 Enrollment ID: I20230306000166 |
| Provider Name | Eli Samuel Neiman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437363538 PECOS PAC ID: 3971662735 Enrollment ID: I20230501000341 |
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