| Lori Russell-siemer Llc | |
|
1703 Peyco Dr N Ste L Arlington TX 76001-6701 | |
| (817) 854-4991 | |
| Not Available |
| Full Name | Lori Russell-siemer Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1703 Peyco Dr N Ste L, Arlington, Texas |
| Authorized Official Name and Position | Lori Russell-siemer (OWNER) |
| Authorized Official Contact | 8177061728 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lori Russell-siemer Llc 1930 Santa Anna Dr Arlington TX 76001-5611 Ph: (817) 706-1728 | Lori Russell-siemer Llc 1703 Peyco Dr N Ste L Arlington TX 76001-6701 Ph: (817) 854-4991 |
| NPI Number | 1588286504 |
|---|---|
| Provider Enumeration Date | 05/13/2020 |
| Last Update Date | 05/13/2020 |
| Certification Date | 05/13/2020 |
| Medicare PECOS PAC ID | 6002237583 |
|---|---|
| Medicare Enrollment ID | O20200609002760 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588286504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lori Russell-siemer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609349489 PECOS PAC ID: 8325371156 Enrollment ID: I20190611002048 |
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