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1103 N Gray St Killeen TX 76541-3420 | |
| (254) 774-1163 | |
| (833) 464-5455 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1103 N Gray St, Killeen, Texas |
| Authorized Official Name and Position | Andrey Shalomov (PRESIDENT) |
| Authorized Official Contact | 2547741163 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 11 Killeen TX 76540-0011 Ph: (254) 774-1163 | 1103 N Gray St Killeen TX 76541-3420 Ph: (254) 774-1163 |
| NPI Number | 1659012839 |
|---|---|
| Provider Enumeration Date | 04/05/2022 |
| Last Update Date | 11/22/2024 |
| Certification Date | 11/22/2024 |
| Medicare PECOS PAC ID | 0941688204 |
|---|---|
| Medicare Enrollment ID | O20220527002219 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659012839 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Andrey Shalomov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750813499 PECOS PAC ID: 2264774173 Enrollment ID: I20220527002227 |
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