| Invicta Family Healthcare Clinic, Pllc | |
|
904 W Moore Ave Ste B Terrell TX 75160-3004 | |
| (972) 563-1475 | |
| (972) 524-5132 |
| Full Name | Invicta Family Healthcare Clinic, Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 904 W Moore Ave Ste B, Terrell, Texas |
| Authorized Official Name and Position | Michael O Idemudia (OWNER) |
| Authorized Official Contact | 9725631475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Invicta Family Healthcare Clinic, Pllc 904 W. Moore Ave. Suite B Forney TX 75126-0228 Ph: (972) 563-1475 | Invicta Family Healthcare Clinic, Pllc 904 W Moore Ave Ste B Terrell TX 75160-3004 Ph: (972) 563-1475 |
| NPI Number | 1093235046 |
|---|---|
| Provider Enumeration Date | 06/21/2017 |
| Last Update Date | 12/19/2024 |
| Medicare PECOS PAC ID | 6507137395 |
|---|---|
| Medicare Enrollment ID | O20170814001146 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093235046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LG0600X | Nurse Practitioner - Gerontology | (Texas) | Primary |
| Provider Name | Michael O Idemudia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306391396 PECOS PAC ID: 3577844729 Enrollment ID: I20161229001283 |
| Provider Name | Nkechi Renneth Idemudia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083169973 PECOS PAC ID: 0648547844 Enrollment ID: I20170907003156 |
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