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2106 E State Highway 114 Ste 300 Southlake TX 76092 | |
(817) 552-4300 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 2106 E State Highway 114, Southlake, Texas |
Authorized Official Name and Position | Walter Gaman (PHYSICIAN/PARTNER) |
Authorized Official Contact | 8173079312 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2106 E State Highway 114 Ste 300 Southlake TX 76092 Ph: (817) 552-4300 | 2106 E State Highway 114 Ste 300 Southlake TX 76092 Ph: (817) 552-4300 |
NPI Number | 1043720154 |
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Provider Enumeration Date | 10/03/2017 |
Last Update Date | 10/03/2017 |
Medicare PECOS PAC ID | 5395150940 |
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Medicare Enrollment ID | O20210212001880 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043720154 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Mediclink Management Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 415 E Southlake Blvd Ste 100, Southlake, TX 76092 Phone: 817-506-4132 | |
Health Matters Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 116 River Oaks Drive, #100, Southlake, TX 76092 Phone: 505-220-6814 | |
Southlake Hospitalists Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1321 Bay Meadows Dr, Southlake, TX 76092 Phone: 817-521-4747 Fax: 214-279-9273 | |
Global Anesthesia Specialists, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 470 E State Highway 114, Southlake, TX 76092 Phone: 214-450-9926 | |
Modern Medical House Calls Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 855 Davis Blvd Ste 500, Southlake, TX 76092 Phone: 817-912-1771 Fax: 940-241-6156 |