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2801 Lemmon Ave Ste 200 Dallas TX 75204-2201 | |
| (469) 687-3200 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2801 Lemmon Ave Ste 200, Dallas, Texas |
| Authorized Official Name and Position | John Thomas Carlo (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2145215191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3900 Junius St Ste 300 Dallas TX 75246-1602 Ph: (214) 521-5191 | 2801 Lemmon Ave Ste 200 Dallas TX 75204-2201 Ph: (469) 687-3200 |
| NPI Number | 1154017242 |
|---|---|
| Provider Enumeration Date | 04/12/2023 |
| Last Update Date | 08/01/2024 |
| Medicare PECOS PAC ID | 7719940774 |
|---|---|
| Medicare Enrollment ID | O20241101001135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154017242 | NPI | - | NPPES |
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