| Texas Premier Medicine | |
|
1631 Lancaster Dr Grapevine TX 76051-3585 | |
| (214) 232-5123 | |
| Not Available |
| Full Name | Texas Premier Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 1631 Lancaster Dr, Grapevine, Texas |
| Authorized Official Name and Position | Edwin Matthews (OWNER) |
| Authorized Official Contact | 2142325123 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Texas Premier Medicine 1631 Lancaster Dr Grapevine TX 76051-3585 | Texas Premier Medicine 1631 Lancaster Dr Grapevine TX 76051-3585 Ph: (214) 232-5123 |
| NPI Number | 1104536721 |
|---|---|
| Provider Enumeration Date | 12/05/2022 |
| Last Update Date | 12/05/2022 |
| Certification Date | 12/05/2022 |
| Medicare PECOS PAC ID | 8820463169 |
|---|---|
| Medicare Enrollment ID | O20230418002855 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104536721 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Edwin Matthews |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588607030 PECOS PAC ID: 5092843839 Enrollment ID: I20100514000396 |
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