| Wade Medical Care Pa | |
|
139 Country Vista Cir Burleson TX 76028-7877 | |
| (325) 716-9182 | |
| Not Available |
| Full Name | Wade Medical Care Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 139 Country Vista Cir, Burleson, Texas |
| Authorized Official Name and Position | Carlos Wade (PRESIDENT AND CEO) |
| Authorized Official Contact | 3257169182 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wade Medical Care Pa 139 Country Vista Cir Burleson TX 76028-7877 Ph: (325) 716-9182 | Wade Medical Care Pa 139 Country Vista Cir Burleson TX 76028-7877 Ph: (325) 716-9182 |
| NPI Number | 1841559069 |
|---|---|
| Provider Enumeration Date | 05/08/2012 |
| Last Update Date | 05/08/2012 |
| Medicare PECOS PAC ID | 1759537475 |
|---|---|
| Medicare Enrollment ID | O20120813000733 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841559069 | NPI | - | NPPES |
| M4631 | Other | TX | LICENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | M4631 (Texas) | Primary |
| Provider Name | Brenda S Piganelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184661795 PECOS PAC ID: 7113986233 Enrollment ID: I20041005000876 |
| Provider Name | Carlos Wade |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598782062 PECOS PAC ID: 8325042096 Enrollment ID: I20060912000135 |
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