<unavail> in Grand Prairie, TX - Medicare Clinic/Center

is a medicare enrolled primary clinic (Clinic/center - Mental Health (including Community Mental Health Center)) in Grand Prairie, Texas. The current practice location for is 2305 Oak Ln Ste 103, Grand Prairie, Texas. For appointments, you can reach them via phone at (469) 626-8195. The mailing address for is 3540 E Broad St # 106-264, Mansfield, Texas and phone number is (469) 626-8195.

is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1679021042. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (469) 626-8195.

Contact Information


	2305 Oak Ln Ste 103 Grand Prairie TX 75051-8243
	(469) 626-8195
	(469) 857-8492

Map and Direction

Primary Care Clinic Profile

Full Name
Speciality	Clinic/Center
Location	2305 Oak Ln Ste 103, Grand Prairie, Texas
Authorized Official Name and Position	Ket Harris (NURSE PRACITITIONER)
Authorized Official Contact	4696268195
Accepts Medicare Insurance	Yes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
3540 E Broad St # 106-264 Mansfield TX 76063-5633 Ph: (469) 626-8195	2305 Oak Ln Ste 103 Grand Prairie TX 75051-8243 Ph: (469) 626-8195

NPI Details:

NPI Number	1679021042
Provider Enumeration Date	09/14/2016
Last Update Date	09/24/2024

Medicare PECOS Information:

Medicare PECOS PAC ID	4082971213
Medicare Enrollment ID	O20171127001367

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1679021042	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207R00000X	Internal Medicine	AP121985 (Texas)	Secondary
251B00000X	Case Management	(* (Not Available))	Secondary
261QM0801X	Clinic/center - Mental Health (including Community Mental Health Center)	(* (Not Available))	Primary
363LF0000X	Nurse Practitioner - Family	AP121985 (Texas)	Secondary
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	(* (Not Available))	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. acts as a billing entity for following providers:

Provider Name	Ket Harris
Provider Type	Practitioner - Nurse Practitioner
Provider Identifiers	NPI Number: 1588911705 PECOS PAC ID: 4789833609 Enrollment ID: I20121009000153

Reviews and Comments

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- Medicare Primary Care in Grand Prairie, TX