Provider On Demand Llc is a medicare enrolled primary clinic (Emergency Medicine) in Lorena, Texas. The current practice location for Provider On Demand Llc is 1199 Old Lorena Rd, Lorena, Texas. For appointments, you can reach them via phone at
(757) 642-5062. The mailing address for Provider On Demand Llc is 1551 W Central Ave, Temple, Texas and phone number is () -.
Provider On Demand Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1013770148. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(757) 642-5062.
Primary Care Clinic Profile
| Full Name | Provider On Demand Llc |
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| Speciality | Emergency Medicine |
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| Location | 1199 Old Lorena Rd, Lorena, Texas |
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| Authorized Official Name and Position | Brett Marvel (COO) |
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| Authorized Official Contact | 7377472200 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Provider On Demand Llc
1551 W Central Ave
Temple
TX 76504-4005
Ph: () - | Provider On Demand Llc
1199 Old Lorena Rd
Lorena
TX 76655-3176
Ph: (757) 642-5062 |
NPI Details:
| NPI Number | 1013770148 |
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| Provider Enumeration Date | 02/01/2024 |
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| Last Update Date | 10/09/2024 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 5092242578 |
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| Medicare Enrollment ID | O20241223000153 |
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Medical Identifiers
Medical identifiers for Provider On Demand Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1013770148 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| 207P00000X | Emergency Medicine | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Provider On Demand Llc acts as a billing entity for following providers:
| Provider Name | Marlene Morales |
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| Provider Type | Practitioner - Emergency Medicine |
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| Provider Identifiers | NPI Number: 1174806335
PECOS PAC ID: 4880854868
Enrollment ID: I20120328001031 |
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| Provider Name | Lorenzo Sanchez |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1548871031
PECOS PAC ID: 2961816350
Enrollment ID: I20210126002009 |
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