| Instaclinic, Llc | |
|
7008 Quartermile Ln Dallas TX 75248-1448 | |
| (307) 256-8556 | |
| Not Available |
| Full Name | Instaclinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7008 Quartermile Ln, Dallas, Texas |
| Authorized Official Name and Position | Amy R Surdam (COO) |
| Authorized Official Contact | 3074217277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Instaclinic, Llc Po Box 1142 Cheyenne WY 82003-1142 Ph: (307) 421-7277 | Instaclinic, Llc 7008 Quartermile Ln Dallas TX 75248-1448 Ph: (307) 256-8556 |
| NPI Number | 1659978401 |
|---|---|
| Provider Enumeration Date | 10/05/2020 |
| Last Update Date | 12/21/2022 |
| Medicare PECOS PAC ID | 2769894997 |
|---|---|
| Medicare Enrollment ID | O20201212000212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659978401 | NPI | - | NPPES |
| 1659978401 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Amy Rebecca Surdam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629099312 PECOS PAC ID: 4587619507 Enrollment ID: I20050623000401 |
| Provider Name | Daniel E Surdam |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1184697666 PECOS PAC ID: 9335174416 Enrollment ID: I20050927001463 |
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