| Midland Visiting Doctors Management Llc | |
|
17330 Preston Rd Ste 170a Dallas TX 75252-5796 | |
| (972) 415-9856 | |
| Not Available |
| Full Name | Midland Visiting Doctors Management Llc |
|---|---|
| Speciality | General Practice |
| Location | 17330 Preston Rd Ste 170a, Dallas, Texas |
| Authorized Official Name and Position | Shibu Joseph (MANAGING MEMBER) |
| Authorized Official Contact | 9724159856 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midland Visiting Doctors Management Llc 17330 Preston Rd Ste 170a Dallas TX 75252-5796 Ph: (469) 242-3826 | Midland Visiting Doctors Management Llc 17330 Preston Rd Ste 170a Dallas TX 75252-5796 Ph: (972) 415-9856 |
| NPI Number | 1851934434 |
|---|---|
| Provider Enumeration Date | 10/25/2019 |
| Last Update Date | 12/06/2023 |
| Medicare PECOS PAC ID | 9739517905 |
|---|---|
| Medicare Enrollment ID | O20200323000128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851934434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Ravikumar Hanumanthaiah Edalur |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023221413 PECOS PAC ID: 5193809465 Enrollment ID: I20080225000770 |
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