| Shalom Gp Medical Group Llc | |
|
600 C-bar Ranch Trail #89 Cedar Park TX 78613 | |
| (510) 334-4171 | |
| Not Available |
| Full Name | Shalom Gp Medical Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 600 C-bar Ranch Trail #89, Cedar Park, Texas |
| Authorized Official Name and Position | Nkechinyere Udenyi (MANAGER) |
| Authorized Official Contact | 5103344171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shalom Gp Medical Group Llc 500 E Whitestone Blvd Unit 3963 Cedar Park TX 78630-4461 Ph: () - | Shalom Gp Medical Group Llc 600 C-bar Ranch Trail #89 Cedar Park TX 78613 Ph: (510) 334-4171 |
| NPI Number | 1265176101 |
|---|---|
| Provider Enumeration Date | 04/26/2022 |
| Last Update Date | 09/16/2022 |
| Medicare PECOS PAC ID | 4789069410 |
|---|---|
| Medicare Enrollment ID | O20220916001442 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265176101 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Secondary |
| Provider Name | Nkechinyere Udenyi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073684783 PECOS PAC ID: 5799887097 Enrollment ID: I20220811002495 |
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