| Melville Medicine, Pllc | |
|
1545 E Southlake Blvd Ste 110 Southlake TX 76092-6464 | |
| (817) 600-8725 | |
| Not Available |
| Full Name | Melville Medicine, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1545 E Southlake Blvd Ste 110, Southlake, Texas |
| Authorized Official Name and Position | Daniel Melville (MEMBER) |
| Authorized Official Contact | 8176008725 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Melville Medicine, Pllc 1545 E Southlake Blvd Ste 110 Southlake TX 76092-6464 Ph: (817) 676-2010 | Melville Medicine, Pllc 1545 E Southlake Blvd Ste 110 Southlake TX 76092-6464 Ph: (817) 600-8725 |
| NPI Number | 1043873771 |
|---|---|
| Provider Enumeration Date | 04/18/2019 |
| Last Update Date | 12/02/2022 |
| Medicare PECOS PAC ID | 0345574661 |
|---|---|
| Medicare Enrollment ID | O20190620000764 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043873771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Secondary |
| Provider Name | Daniel E Melville |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881646255 PECOS PAC ID: 7719990753 Enrollment ID: I20130124000084 |
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