| Sasosa Professional Corporation | |
|
1925 E Belt Line Rd Ste 208 Carrollton TX 75006-5826 | |
| (972) 666-9200 | |
| (469) 900-8090 |
| Full Name | Sasosa Professional Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 1925 E Belt Line Rd Ste 208, Carrollton, Texas |
| Authorized Official Name and Position | Lottie M. Everett (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 9726669200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sasosa Professional Corporation 1925 E Belt Line Rd Ste 208 Carrollton TX 75006-5826 Ph: (972) 666-9200 | Sasosa Professional Corporation 1925 E Belt Line Rd Ste 208 Carrollton TX 75006-5826 Ph: (972) 666-9200 |
| NPI Number | 1053936856 |
|---|---|
| Provider Enumeration Date | 06/08/2020 |
| Last Update Date | 08/17/2021 |
| Medicare PECOS PAC ID | 9931528536 |
|---|---|
| Medicare Enrollment ID | O20201001000398 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053936856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lottie M Everett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285129460 PECOS PAC ID: 4587906128 Enrollment ID: I20190430001976 |
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