| |
904 W Moore Ave Ste B Terrell TX 75160-3004 | |
(972) 563-1475 | |
(972) 524-5132 |
Full Name | |
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Speciality | Nurse Practitioner |
Location | 904 W Moore Ave Ste B, Terrell, Texas |
Authorized Official Name and Position | Michael O Idemudia (OWNER) |
Authorized Official Contact | 9725631475 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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904 W. Moore Ave. Suite B Forney TX 75126-0228 Ph: (972) 563-1475 | 904 W Moore Ave Ste B Terrell TX 75160-3004 Ph: (972) 563-1475 |
NPI Number | 1093235046 |
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Provider Enumeration Date | 06/21/2017 |
Last Update Date | 12/19/2024 |
Medicare PECOS PAC ID | 6507137395 |
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Medicare Enrollment ID | O20170814001146 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093235046 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
363LG0600X | Nurse Practitioner - Gerontology | (Texas) | Primary |
Provider Name | Michael O Idemudia |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306391396 PECOS PAC ID: 3577844729 Enrollment ID: I20161229001283 |
Provider Name | Nkechi Renneth Idemudia |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083169973 PECOS PAC ID: 0648547844 Enrollment ID: I20170907003156 |
Priti B. Vyas; M.d. P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 809 W Nash St, Terrell, TX 75160 Phone: 972-563-6493 | |
Regional Health Clinic At Terrell Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1553 State Highway 34 S, Ste 100, Terrell, TX 75160 Phone: 972-563-1475 Fax: 972-524-5132 | |