| Promenade Family Medicine | |
|
1120 W Campbell Rd Suite 111 Richardson TX 75080-2976 | |
| (972) 234-6868 | |
| (972) 238-1235 |
| Full Name | Promenade Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1120 W Campbell Rd, Richardson, Texas |
| Authorized Official Name and Position | Adam S Miner (PHYSICIAN/OWNER) |
| Authorized Official Contact | 9722346868 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Promenade Family Medicine Po Box 796534 Dallas TX 75379-6534 Ph: (972) 234-6868 | Promenade Family Medicine 1120 W Campbell Rd Suite 111 Richardson TX 75080-2976 Ph: (972) 234-6868 |
| NPI Number | 1245416619 |
|---|---|
| Provider Enumeration Date | 01/16/2008 |
| Last Update Date | 05/15/2009 |
| Medicare PECOS PAC ID | 8527111269 |
|---|---|
| Medicare Enrollment ID | O20090729000131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245416619 | NPI | - | NPPES |
| 080185401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | J2689 (Texas) | Primary |
| 261Q00000X | Clinic/center | J2689 (Texas) | Secondary |
| Provider Name | Adam S Miner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467454603 PECOS PAC ID: 2365595006 Enrollment ID: I20090729000118 |
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