| Proliferativemed Pllc | |
|
731 E Southlake Blvd Ste 110 Southlake TX 76092-6378 | |
| (817) 917-6197 | |
| Not Available |
| Full Name | Proliferativemed Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 731 E Southlake Blvd Ste 110, Southlake, Texas |
| Authorized Official Name and Position | Steven B. Sanders (OWNER) |
| Authorized Official Contact | 9728393777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proliferativemed Pllc 615 W Lamar St Mckinney TX 75069-3848 Ph: (817) 917-6197 | Proliferativemed Pllc 731 E Southlake Blvd Ste 110 Southlake TX 76092-6378 Ph: (817) 917-6197 |
| NPI Number | 1467082438 |
|---|---|
| Provider Enumeration Date | 01/18/2020 |
| Last Update Date | 01/18/2020 |
| Medicare PECOS PAC ID | 0446675193 |
|---|---|
| Medicare Enrollment ID | O20200729001271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467082438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Steven B Sanders |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1346282225 PECOS PAC ID: 6204747546 Enrollment ID: I20100222000323 |
| Provider Name | Nicolina Egydia Mboya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245705383 PECOS PAC ID: 9739428897 Enrollment ID: I20190307000443 |
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