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1534-a N Hampton Road Suite 100 Desoto TX 75115-0073 | |
| (469) 585-8129 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1534-a N Hampton Road, Desoto, Texas |
| Authorized Official Name and Position | Patrick Moneke (ADMINISTRATOR) |
| Authorized Official Contact | 8173660950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1534a N Hampton Rd Desoto TX 75115-2302 Ph: () - | 1534-a N Hampton Road Suite 100 Desoto TX 75115-0073 Ph: (469) 585-8129 |
| NPI Number | 1750144150 |
|---|---|
| Provider Enumeration Date | 01/30/2024 |
| Last Update Date | 06/28/2024 |
| Medicare PECOS PAC ID | 3779924048 |
|---|---|
| Medicare Enrollment ID | O20240517000448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750144150 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Nadear A Elmahi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639278799 PECOS PAC ID: 8426059106 Enrollment ID: I20140718001674 |
| Provider Name | Siminibe P Moneke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861902934 PECOS PAC ID: 0446526297 Enrollment ID: I20171023000210 |
| Provider Name | Mable Victoria Pankaj |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639592926 PECOS PAC ID: 1153746367 Enrollment ID: I20200805002150 |
| Provider Name | Diane M Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427467422 PECOS PAC ID: 7618197815 Enrollment ID: I20210813002688 |
| Provider Name | Rachelle S Desyr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790538981 PECOS PAC ID: 3870025521 Enrollment ID: I20241018001729 |
| Provider Name | Chloe E O'brien |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1366264863 PECOS PAC ID: 4688108087 Enrollment ID: I20241211003995 |
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