Lewisville Diagnostic Center | |
125 N Cowan Ave Suite 102 Lewisville TX 75057-3737 | |
(972) 221-0600 | |
(972) 221-8265 |
Full Name | Lewisville Diagnostic Center |
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Speciality | Internal Medicine |
Location | 125 N Cowan Ave, Lewisville, Texas |
Authorized Official Name and Position | Emmanuel F Desai (OWNER) |
Authorized Official Contact | 9722210600 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lewisville Diagnostic Center 125 N Cowan Ave Suite 102 Lewisville TX 75057-3737 Ph: (972) 221-0600 | Lewisville Diagnostic Center 125 N Cowan Ave Suite 102 Lewisville TX 75057-3737 Ph: (972) 221-0600 |
NPI Number | 1326263328 |
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Provider Enumeration Date | 04/16/2007 |
Last Update Date | 06/16/2023 |
Medicare PECOS PAC ID | 1355538455 |
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Medicare Enrollment ID | O20101214001114 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326263328 | NPI | - | NPPES |
145407601 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | E9603 (Texas) | Primary |
Provider Name | Emmanuel F Desai |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1841234655 PECOS PAC ID: 6305981028 Enrollment ID: I20101214001141 |
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