| Edwards Dfw | |
|
5637 N Tarrant Pkwy Ste B Fort Worth TX 76244-7321 | |
| (855) 934-1178 | |
| Not Available |
| Full Name | Edwards Dfw |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5637 N Tarrant Pkwy Ste B, Fort Worth, Texas |
| Authorized Official Name and Position | Ashley Blair Elder (REVENUE CYCLE ADMIN) |
| Authorized Official Contact | 7372471223 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edwards Dfw 2205 Cordillera Way Edwards CO 81632-6290 Ph: (737) 247-1223 | Edwards Dfw 5637 N Tarrant Pkwy Ste B Fort Worth TX 76244-7321 Ph: (855) 934-1178 |
| NPI Number | 1275308991 |
|---|---|
| Provider Enumeration Date | 11/22/2023 |
| Last Update Date | 04/02/2024 |
| Medicare PECOS PAC ID | 9739528142 |
|---|---|
| Medicare Enrollment ID | O20240418001526 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275308991 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | James Montgomery |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861469603 PECOS PAC ID: 7416007034 Enrollment ID: I20090602000520 |
| Provider Name | Carmen L Pemberton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407140916 PECOS PAC ID: 6608033469 Enrollment ID: I20120206000703 |
| Provider Name | Manish M Nair |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851531982 PECOS PAC ID: 4981514544 Enrollment ID: I20160125002484 |
| Provider Name | Katrina Coulter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184255325 PECOS PAC ID: 2668801481 Enrollment ID: I20200330003714 |
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