| Magnolia House Calls Llc | |
|
202 Fisherman Trail Melissa TX 75454 | |
| (469) 667-4787 | |
| Not Available |
| Full Name | Magnolia House Calls Llc |
|---|---|
| Speciality | General Practice |
| Location | 202 Fisherman Trail, Melissa, Texas |
| Authorized Official Name and Position | Sherry L Martin (ADMINISTER) |
| Authorized Official Contact | 4696674787 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia House Calls Llc 202 Fisherman Trail Melissa TX 75454 Ph: (469) 667-4787 | Magnolia House Calls Llc 202 Fisherman Trail Melissa TX 75454 Ph: (469) 667-4787 |
| NPI Number | 1386279206 |
|---|---|
| Provider Enumeration Date | 03/11/2020 |
| Last Update Date | 03/11/2020 |
| Medicare PECOS PAC ID | 3870924707 |
|---|---|
| Medicare Enrollment ID | O20200511000048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386279206 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Muhammad Khan |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1396700043 PECOS PAC ID: 0244224012 Enrollment ID: I20110504000537 |
| Provider Name | Kristina Crews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033470711 PECOS PAC ID: 6103240387 Enrollment ID: I20200721002136 |
| Provider Name | Kimberly Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619487907 PECOS PAC ID: 2961812805 Enrollment ID: I20201105000245 |
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