| Pvc Family Practice | |
|
3334 Broadway Blvd Ste 422 Garland TX 75043-1575 | |
| (972) 979-7408 | |
| (972) 587-6733 |
| Full Name | Pvc Family Practice |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 3334 Broadway Blvd Ste 422, Garland, Texas |
| Authorized Official Name and Position | Zainabu Koroma (ADMINISTRATOR) |
| Authorized Official Contact | 9729797408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pvc Family Practice 3334 Broadway Blvd Ste 422 Garland TX 75043-1575 Ph: (972) 979-7408 | Pvc Family Practice 3334 Broadway Blvd Ste 422 Garland TX 75043-1575 Ph: (972) 979-7408 |
| NPI Number | 1720468390 |
|---|---|
| Provider Enumeration Date | 06/09/2015 |
| Last Update Date | 10/18/2021 |
| Certification Date | 10/18/2021 |
| Medicare PECOS PAC ID | 2668785791 |
|---|---|
| Medicare Enrollment ID | O20150720000799 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720468390 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | L5507 (Texas) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | AP120628 (Texas) | Primary |
| Provider Name | Mary K Hood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902878770 PECOS PAC ID: 3476575200 Enrollment ID: I20051221000394 |
| Provider Name | Chirag H Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669439279 PECOS PAC ID: 5294744876 Enrollment ID: I20060410000314 |
| Provider Name | Zainabu Koroma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699053553 PECOS PAC ID: 4981797248 Enrollment ID: I20110921000840 |
| Provider Name | Deborah Larbie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356717235 PECOS PAC ID: 1355364902 Enrollment ID: I20150915000098 |
| Provider Name | Diana Karihe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467911495 PECOS PAC ID: 2668713108 Enrollment ID: I20190409003258 |
| Provider Name | Jane Yatta Mcarthy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235793175 PECOS PAC ID: 9335230622 Enrollment ID: I20190530001273 |
| Provider Name | Ekele Adaeze Ezirim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780456657 PECOS PAC ID: 8224503784 Enrollment ID: I20260413001051 |
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