| Kelly L Wimberly Md Pa | |
|
17101 Preston Rd Suite 200 Dallas TX 75248-1331 | |
| (972) 239-4441 | |
| (972) 239-1597 |
| Full Name | Kelly L Wimberly Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 17101 Preston Rd, Dallas, Texas |
| Authorized Official Name and Position | Kelly L Wimberly (OWNER) |
| Authorized Official Contact | 9722394441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly L Wimberly Md Pa 17101 Preston Rd Suite 200 Dallas TX 75248-1331 Ph: (972) 239-4441 | Kelly L Wimberly Md Pa 17101 Preston Rd Suite 200 Dallas TX 75248-1331 Ph: (972) 239-4441 |
| NPI Number | 1578589842 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 07/24/2008 |
| Medicare PECOS PAC ID | 2961497078 |
|---|---|
| Medicare Enrollment ID | O20041018000420 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578589842 | NPI | - | NPPES |
| DH1426 | Other | TX | MEDICARE RR GROUP NUMBER |
| P00474586 | Other | TX | MEDICARE RR PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | J3002 (Texas) | Primary |
| Provider Name | Kelly L Wimberly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053330803 PECOS PAC ID: 2668467770 Enrollment ID: I20041018000439 |
Perry K. Beckstrom, Do Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3946 S Buckner Blvd Ste 200, Dallas, TX 75227 Phone: 214-381-7194 Fax: 214-381-7195 | |
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