| Southlake Physical Medicine Pllc | |
|
1500 W Southlake Blvd Suite 120 Southlake TX 76092-5950 | |
| (817) 416-6116 | |
| Not Available |
| Full Name | Southlake Physical Medicine Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1500 W Southlake Blvd, Southlake, Texas |
| Authorized Official Name and Position | Gary Tigges (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9729818345 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlake Physical Medicine Pllc 1500 W Southlake Blvd Suite 120 Southlake TX 76092-5950 Ph: () - | Southlake Physical Medicine Pllc 1500 W Southlake Blvd Suite 120 Southlake TX 76092-5950 Ph: (817) 416-6116 |
| NPI Number | 1083088900 |
|---|---|
| Provider Enumeration Date | 11/16/2015 |
| Last Update Date | 04/29/2016 |
| Medicare PECOS PAC ID | 0244517514 |
|---|---|
| Medicare Enrollment ID | O20170516000764 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083088900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Tyce D Hergert |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1588659825 PECOS PAC ID: 2365487972 Enrollment ID: I20050623001018 |
| Provider Name | Philip Talley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720402365 PECOS PAC ID: 2163640996 Enrollment ID: I20170324000371 |
Mediclink Management Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 415 E Southlake Blvd Ste 100, Southlake, TX 76092 Phone: 817-506-4132 | |
Southlake Hospitalists Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1321 Bay Meadows Dr, Southlake, TX 76092 Phone: 817-521-4747 Fax: 214-279-9273 | |
Global Anesthesia Specialists, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 470 E State Highway 114, Southlake, TX 76092 Phone: 214-450-9926 | |
Hospital Medicine Consultants Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2009 Woodbury Ct, Southlake, TX 76092 Phone: 972-352-0920 | |
Modern Medical House Calls Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 855 Davis Blvd Ste 500, Southlake, TX 76092 Phone: 817-912-1771 Fax: 940-241-6156 | |
Executive Medicine Of Texas Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2106 E State Highway 114, Ste 300, Southlake, TX 76092 Phone: 817-552-4300 | |
Melville Medicine, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1545 E Southlake Blvd Ste 110, Southlake, TX 76092 Phone: 817-600-8725 |