| Renovar Wellcare Pllc | |
|
1509 W Hebron Pkwy Ste 140 Carrollton TX 75010-6492 | |
| (972) 306-0016 | |
| (972) 306-0017 |
| Full Name | Renovar Wellcare Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1509 W Hebron Pkwy Ste 140, Carrollton, Texas |
| Authorized Official Name and Position | Olusesan Oluseun Olotu (DIRECTOR) |
| Authorized Official Contact | 9723060016 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renovar Wellcare Pllc 8533 Royal County Down Dr Mckinney TX 75070-1680 Ph: (972) 306-0016 | Renovar Wellcare Pllc 1509 W Hebron Pkwy Ste 140 Carrollton TX 75010-6492 Ph: (972) 306-0016 |
| NPI Number | 1013407451 |
|---|---|
| Provider Enumeration Date | 05/10/2018 |
| Last Update Date | 07/10/2022 |
| Medicare PECOS PAC ID | 5092061994 |
|---|---|
| Medicare Enrollment ID | O20180709000147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013407451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Olusesan Oluseun Olotu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366882623 PECOS PAC ID: 1153610399 Enrollment ID: I20161101001762 |
| Provider Name | Alice Ann Bagby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972298842 PECOS PAC ID: 5991152597 Enrollment ID: I20231102003827 |
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