| |
1925 E Belt Line Rd Ste 208 Carrollton TX 75006-5826 | |
(972) 666-9200 | |
(469) 900-8090 |
Full Name | |
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Speciality | Family Medicine |
Location | 1925 E Belt Line Rd Ste 208, Carrollton, Texas |
Authorized Official Name and Position | Lottie M. Everett (CHIEF ADMINISTRATIVE OFFICER) |
Authorized Official Contact | 9726669200 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1925 E Belt Line Rd Ste 208 Carrollton TX 75006-5826 Ph: (972) 666-9200 | 1925 E Belt Line Rd Ste 208 Carrollton TX 75006-5826 Ph: (972) 666-9200 |
NPI Number | 1053936856 |
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Provider Enumeration Date | 06/08/2020 |
Last Update Date | 08/17/2021 |
Medicare PECOS PAC ID | 9931528536 |
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Medicare Enrollment ID | O20201001000398 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053936856 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Lottie M Everett |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285129460 PECOS PAC ID: 4587906128 Enrollment ID: I20190430001976 |
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