| Simon S Tan, Md Pa | |
|
731 E Southlake Blvd Ste 170 Southlake TX 76092-6382 | |
| (817) 488-0100 | |
| (817) 488-4568 |
| Full Name | Simon S Tan, Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 731 E Southlake Blvd Ste 170, Southlake, Texas |
| Authorized Official Name and Position | Simon Sy Tan (PRESIDENT) |
| Authorized Official Contact | 8174880100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Simon S Tan, Md Pa 3600 William D Tate Ave Suite 200 Grapevine TX 76051-8723 Ph: (817) 488-0100 | Simon S Tan, Md Pa 731 E Southlake Blvd Ste 170 Southlake TX 76092-6382 Ph: (817) 488-0100 |
| NPI Number | 1326152851 |
|---|---|
| Provider Enumeration Date | 08/19/2006 |
| Last Update Date | 10/22/2018 |
| Medicare PECOS PAC ID | 7315848918 |
|---|---|
| Medicare Enrollment ID | O20040116000465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326152851 | NPI | - | NPPES |
| 0001JA | Other | TX | BCBS |
| 151996901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | L2023 (Texas) | Primary |
| Provider Name | Simon Sy Tan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811001365 PECOS PAC ID: 2567363187 Enrollment ID: I20101008000268 |
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