| Irving Coppell Primary Care Doctors Pllc | |
|
309 Regency Pkwy Suite #107 Mansfield TX 76063-5165 | |
| (972) 905-3915 | |
| (940) 205-4525 |
| Full Name | Irving Coppell Primary Care Doctors Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 309 Regency Pkwy, Mansfield, Texas |
| Authorized Official Name and Position | Vijayalakshmi Raghu (OWNER/PROVIDER) |
| Authorized Official Contact | 9729053915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Irving Coppell Primary Care Doctors Pllc Po Box 15885 Belfast ME 04915-4053 Ph: (972) 905-3915 | Irving Coppell Primary Care Doctors Pllc 309 Regency Pkwy Suite #107 Mansfield TX 76063-5165 Ph: (972) 905-3915 |
| NPI Number | 1871973867 |
|---|---|
| Provider Enumeration Date | 06/04/2015 |
| Last Update Date | 10/21/2015 |
| Medicare PECOS PAC ID | 8123336716 |
|---|---|
| Medicare Enrollment ID | O20151001000263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871973867 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Vijayalakshmi Raghu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225220940 PECOS PAC ID: 2961575352 Enrollment ID: I20111216000357 |
| Provider Name | Babita Khatri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144758020 PECOS PAC ID: 4082971098 Enrollment ID: I20171129003081 |
| Provider Name | Raghu R Turebylu |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154349199 PECOS PAC ID: 0648373977 Enrollment ID: I20171207001551 |
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