| |
3044 Old Denton Rd Ste 317 Carrollton TX 75007-5017 | |
(972) 242-4440 | |
(972) 242-4949 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3044 Old Denton Rd Ste 317, Carrollton, Texas |
Authorized Official Name and Position | Shahriar Setoudeh-maram (OWNER) |
Authorized Official Contact | 2145853969 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3044 Old Denton Rd Ste 317 Carrollton TX 75007-5017 Ph: (972) 242-4440 | 3044 Old Denton Rd Ste 317 Carrollton TX 75007-5017 Ph: (972) 242-4440 |
NPI Number | 1295053973 |
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Provider Enumeration Date | 05/05/2010 |
Last Update Date | 03/19/2014 |
Medicare PECOS PAC ID | 9931232469 |
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Medicare Enrollment ID | O20100804000070 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295053973 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Shahriar Setoudeh-maram |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1619950359 PECOS PAC ID: 9032138219 Enrollment ID: I20080506000778 |
Provider Name | Hong P Nguyen |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1699015040 PECOS PAC ID: 0244476828 Enrollment ID: I20130426000645 |
Provider Name | Brittany Dirdack |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1316473671 PECOS PAC ID: 2860750593 Enrollment ID: I20171229000459 |
Provider Name | Shannon Nicole Rice |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538705132 PECOS PAC ID: 1052722949 Enrollment ID: I20201125001201 |
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