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701 Tuscan 280 Irving TX 75039-3834 | |
| (214) 496-0500 | |
| (214) 496-0922 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 701 Tuscan, Irving, Texas |
| Authorized Official Name and Position | Tracy Robinson (BILLER) |
| Authorized Official Contact | 2142956081 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
701 Tuscan 280 Irving TX 75039-3834 Ph: (214) 496-0500 | 701 Tuscan 280 Irving TX 75039-3834 Ph: (214) 496-0500 |
| NPI Number | 1174713150 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 10/24/2008 |
| Medicare PECOS PAC ID | 2961449418 |
|---|---|
| Medicare Enrollment ID | O20050415000290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174713150 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 2084S0012X | Psychiatry & Neurology - Sleep Medicine | (* (Not Available)) | Secondary |
| Provider Name | Henry G Raroque |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023077567 PECOS PAC ID: 5890766612 Enrollment ID: I20040804001491 |
| Provider Name | Louis Degironemo |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1972732642 PECOS PAC ID: 7810116100 Enrollment ID: I20140918001768 |
| Provider Name | Erica B Hegeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356753040 PECOS PAC ID: 2365746542 Enrollment ID: I20160209000725 |
| Provider Name | Priscilla Galliguez Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578069381 PECOS PAC ID: 4284041336 Enrollment ID: I20210407002696 |
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