| Sandia Neurology Group Pa | |
|
1515 10th St Wichita Falls TX 76301-4404 | |
| (940) 723-7000 | |
| (940) 723-7007 |
| Full Name | Sandia Neurology Group Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1515 10th St, Wichita Falls, Texas |
| Authorized Official Name and Position | Sandra Christopher (BILLING MANAGER) |
| Authorized Official Contact | 9407237000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandia Neurology Group Pa 1515 10th St Wichita Falls TX 76301-4404 Ph: (940) 723-7000 | Sandia Neurology Group Pa 1515 10th St Wichita Falls TX 76301-4404 Ph: (940) 723-7000 |
| NPI Number | 1659516680 |
|---|---|
| Provider Enumeration Date | 12/04/2008 |
| Last Update Date | 10/01/2020 |
| Certification Date | 10/01/2020 |
| Medicare PECOS PAC ID | 9931263290 |
|---|---|
| Medicare Enrollment ID | O20090130000591 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659516680 | NPI | - | NPPES |
| 2005472-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Jessica L Schultz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1770561912 PECOS PAC ID: 4688643646 Enrollment ID: I20040928000206 |
| Provider Name | Kimberly Jo Pollock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932573318 PECOS PAC ID: 0749584357 Enrollment ID: I20170303000956 |
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