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1605 N Garland Ave Ste A Garland TX 75040-9418 | |
| (214) 501-4135 | |
| (214) 501-4134 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1605 N Garland Ave Ste A, Garland, Texas |
| Authorized Official Name and Position | Sergio Calixto-montanez (SOLE PROPRIETOR) |
| Authorized Official Contact | 4696097483 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1605 N Garland Ave Ste A Garland TX 75040-9418 Ph: (469) 609-7483 | 1605 N Garland Ave Ste A Garland TX 75040-9418 Ph: (214) 501-4135 |
| NPI Number | 1083453708 |
|---|---|
| Provider Enumeration Date | 05/22/2024 |
| Last Update Date | 11/25/2024 |
| Medicare PECOS PAC ID | 2860937638 |
|---|---|
| Medicare Enrollment ID | O20240716004856 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083453708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Sergio Calixto-montanez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316268162 PECOS PAC ID: 7416184684 Enrollment ID: I20131213000678 |
| Provider Name | Sarah Jean Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346529138 PECOS PAC ID: 0840628822 Enrollment ID: I20200325003112 |
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