| Southlake Hospitalists Llc | |
|
1321 Bay Meadows Dr Southlake TX 76092-3938 | |
| (817) 521-4747 | |
| (214) 279-9273 |
| Full Name | Southlake Hospitalists Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1321 Bay Meadows Dr, Southlake, Texas |
| Authorized Official Name and Position | Elizabeth M Chandy (OWNER) |
| Authorized Official Contact | 8175214747 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlake Hospitalists Llc Po Box 92941 Southlake TX 76092-0941 Ph: (817) 521-4747 | Southlake Hospitalists Llc 1321 Bay Meadows Dr Southlake TX 76092-3938 Ph: (817) 521-4747 |
| NPI Number | 1033564729 |
|---|---|
| Provider Enumeration Date | 04/29/2016 |
| Last Update Date | 04/29/2016 |
| Medicare PECOS PAC ID | 2365731403 |
|---|---|
| Medicare Enrollment ID | O20160513000117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033564729 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | M1046 (Texas) | Primary |
| Provider Name | Elizabeth Chandy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891741179 PECOS PAC ID: 3870518582 Enrollment ID: I20051012000196 |
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