| Fort Worth Lung Clinic, Pa | |
|
11803 South Fwy Ste 311 Burleson TX 76028-7036 | |
| (817) 568-8411 | |
| (817) 568-8414 |
| Full Name | Fort Worth Lung Clinic, Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 11803 South Fwy Ste 311, Burleson, Texas |
| Authorized Official Name and Position | Dereje Sahel Ayo (PRESIDENT) |
| Authorized Official Contact | 8177391080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Worth Lung Clinic, Pa Po Box 16284 Fort Worth TX 76162-0284 Ph: (817) 739-1080 | Fort Worth Lung Clinic, Pa 11803 South Fwy Ste 311 Burleson TX 76028-7036 Ph: (817) 568-8411 |
| NPI Number | 1558655274 |
|---|---|
| Provider Enumeration Date | 05/31/2011 |
| Last Update Date | 10/11/2021 |
| Medicare PECOS PAC ID | 6204007123 |
|---|---|
| Medicare Enrollment ID | O20110923000606 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558655274 | NPI | - | NPPES |
| N0617 | Other | TX | LICENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | N0617 (Texas) | Primary |
| Provider Name | Dereje Md Ayo |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1295705325 PECOS PAC ID: 1254358450 Enrollment ID: I20090109000031 |
| Provider Name | Cheryl D Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376081752 PECOS PAC ID: 8123305638 Enrollment ID: I20170511000650 |
| Provider Name | Victoria M Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972051753 PECOS PAC ID: 6305126293 Enrollment ID: I20171002000871 |
| Provider Name | Jeremiah Isaac Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932663812 PECOS PAC ID: 5799024329 Enrollment ID: I20190226003239 |
| Provider Name | Steven James Shook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043862733 PECOS PAC ID: 3173854346 Enrollment ID: I20191021000404 |
| Provider Name | Miriam E Merneigh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669028320 PECOS PAC ID: 6709118714 Enrollment ID: I20191024000672 |
| Provider Name | Rebecca Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962045955 PECOS PAC ID: 4385078278 Enrollment ID: I20191231001758 |
| Provider Name | Edward Vasquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467114470 PECOS PAC ID: 9436548831 Enrollment ID: I20211104002480 |
Rediclinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 951 Sw Wilshire Blvd, Burleson, TX 76028 Phone: 866-607-7334 | |
Delta Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12001 South Fwy, Suite 210, Burleson, TX 76028 Phone: 817-293-8797 | |
Well Crest Medical Clinic Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 11803 South Fwy Ste 205, Burleson, TX 76028 Phone: 817-615-8627 | |
Muhammad Anis Memon M.d. P A Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 E Rendon Crowley Rd, Burleson, TX 76028 Phone: 817-293-9292 | |
Arbor Internal Medicine Association Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 Sw Alsbury Blvd Unit D, Burleson, TX 76028 Phone: 317-450-9811 Fax: 817-285-5556 | |
Texas Health Rx Pharmacy Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 12333 Bear Plz Ste 100, Burleson, TX 76028 Phone: 817-789-4099 Fax: 800-616-4641 | |
Lalitha Jagadish, M.d., P.a Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 11803 South Fwy, Suite 201, Burleson, TX 76028 Phone: 817-293-4800 Fax: 817-293-4808 |