| Eliora Llc | |
|
305 Trail Dust Dr Southlake TX 76092-5733 | |
| (817) 807-1714 | |
| (917) 898-1391 |
| Full Name | Eliora Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 305 Trail Dust Dr, Southlake, Texas |
| Authorized Official Name and Position | Lauretta U Ogbue (OWNER) |
| Authorized Official Contact | 8178071714 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eliora Llc 2600 E Southlake Blvd Ste 120-342 Southlake TX 76092-6634 Ph: () - | Eliora Llc 305 Trail Dust Dr Southlake TX 76092-5733 Ph: (817) 807-1714 |
| NPI Number | 1881465367 |
|---|---|
| Provider Enumeration Date | 01/12/2024 |
| Last Update Date | 01/12/2024 |
| Medicare PECOS PAC ID | 4688011125 |
|---|---|
| Medicare Enrollment ID | O20240320001692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881465367 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Lauretta U Ogbue |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003807462 PECOS PAC ID: 2062478092 Enrollment ID: I20070806000510 |
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