| Prime Md Geriatrics, Pllc | |
|
452 State Highway 121 Unit 130 Coppell TX 75019-4275 | |
| (972) 393-1699 | |
| (972) 393-1702 |
| Full Name | Prime Md Geriatrics, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 452 State Highway 121 Unit 130, Coppell, Texas |
| Authorized Official Name and Position | Divyaswapnika Javvaji (MANAGER) |
| Authorized Official Contact | 9723931699 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Md Geriatrics, Pllc 452 State Highway 121 Unit 130 Coppell TX 75019-4275 Ph: (972) 393-1699 | Prime Md Geriatrics, Pllc 452 State Highway 121 Unit 130 Coppell TX 75019-4275 Ph: (972) 393-1699 |
| NPI Number | 1487156139 |
|---|---|
| Provider Enumeration Date | 03/07/2018 |
| Last Update Date | 06/07/2024 |
| Medicare PECOS PAC ID | 3173874955 |
|---|---|
| Medicare Enrollment ID | O20180918000620 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487156139 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Divyaswapnika Javvaji |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1003176975 PECOS PAC ID: 0446567887 Enrollment ID: I20181018002283 |
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