| Modoma | |
|
4944 Preston Rd Ste 100a Frisco TX 75034-8987 | |
| (469) 304-3443 | |
| (469) 304-3443 |
| Full Name | Modoma |
|---|---|
| Speciality | Family Medicine |
| Location | 4944 Preston Rd Ste 100a, Frisco, Texas |
| Authorized Official Name and Position | Jason Marchetti (OWNER) |
| Authorized Official Contact | 2144024825 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modoma 4944 Preston Rd Suite 100a Frisco TX 75034-8597 Ph: (469) 304-3443 | Modoma 4944 Preston Rd Ste 100a Frisco TX 75034-8987 Ph: (469) 304-3443 |
| NPI Number | 1851839815 |
|---|---|
| Provider Enumeration Date | 02/09/2017 |
| Last Update Date | 05/02/2023 |
| Medicare PECOS PAC ID | 8022482843 |
|---|---|
| Medicare Enrollment ID | O20230317002111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851839815 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208100000X | Physical Medicine & Rehabilitation | L7470 (Texas) | Secondary |
| Provider Name | Jason Marc Marchetti |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1780629469 PECOS PAC ID: 3274578869 Enrollment ID: I20050623000807 |
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