Lewisville Wound Care Center | |
502 N Valley Pkwy Ste 1 Lewisville TX 75067-3437 | |
(972) 316-0902 | |
(972) 316-1161 |
Full Name | Lewisville Wound Care Center |
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Speciality | Internal Medicine |
Location | 502 N Valley Pkwy Ste 1, Lewisville, Texas |
Authorized Official Name and Position | Jalil Aziz Khan (MANGING MEMBER) |
Authorized Official Contact | 9723160902 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lewisville Wound Care Center 502 N Valley Pkwy Ste 1 Lewisville TX 75067-3437 Ph: (972) 316-0902 | Lewisville Wound Care Center 502 N Valley Pkwy Ste 1 Lewisville TX 75067-3437 Ph: (972) 316-0902 |
NPI Number | 1922511898 |
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Provider Enumeration Date | 11/14/2017 |
Last Update Date | 12/21/2017 |
Medicare PECOS PAC ID | 1759640345 |
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Medicare Enrollment ID | O20180104000752 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922511898 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | J9128 (Texas) | Primary |
2083P0011X | Preventive Medicine - Undersea And Hyperbaric Medicine | (* (Not Available)) | Secondary |
Provider Name | Jalil Khan |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1821183435 PECOS PAC ID: 0042279192 Enrollment ID: I20041006000181 |
Provider Name | Reena Mathew |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033550645 PECOS PAC ID: 2163666793 Enrollment ID: I20130920000030 |
Provider Name | Sheeba George |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1093146953 PECOS PAC ID: 7618100132 Enrollment ID: I20140507000378 |
Provider Name | Bhawana Pradhan |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295252195 PECOS PAC ID: 6507132974 Enrollment ID: I20171031000250 |
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