| Musgrave Specialized Care, Pllc | |
|
3061 W Southlake Blvd Ste 130 Southlake TX 76092-0314 | |
| (214) 668-0414 | |
| Not Available |
| Full Name | Musgrave Specialized Care, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 3061 W Southlake Blvd Ste 130, Southlake, Texas |
| Authorized Official Name and Position | Dana Gassaway (ADMINISTRATOR) |
| Authorized Official Contact | 2146680414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Musgrave Specialized Care, Pllc 251 E Southlake Blvd Southlake TX 76092-6269 Ph: () - | Musgrave Specialized Care, Pllc 3061 W Southlake Blvd Ste 130 Southlake TX 76092-0314 Ph: (214) 668-0414 |
| NPI Number | 1750008181 |
|---|---|
| Provider Enumeration Date | 10/26/2022 |
| Last Update Date | 06/22/2023 |
| Medicare PECOS PAC ID | 4385012996 |
|---|---|
| Medicare Enrollment ID | O20221201001002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750008181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | William L Musgrave |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770898306 PECOS PAC ID: 3375783012 Enrollment ID: I20140425000939 |
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