| Vital Physician House Calls Llc | |
|
275 W Campbell Rd Ste 325e Richardson TX 75080-3601 | |
| (972) 666-0786 | |
| (972) 666-0535 |
| Full Name | Vital Physician House Calls Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 275 W Campbell Rd Ste 325e, Richardson, Texas |
| Authorized Official Name and Position | Mansoor Kazi (DIRECTOR) |
| Authorized Official Contact | 9729000207 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital Physician House Calls Llc 275 W Campbell Rd Ste 325e Richardson TX 75080-3601 Ph: (972) 666-0786 | Vital Physician House Calls Llc 275 W Campbell Rd Ste 325e Richardson TX 75080-3601 Ph: (972) 666-0786 |
| NPI Number | 1225650468 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 11/13/2023 |
| Medicare PECOS PAC ID | 2163843616 |
|---|---|
| Medicare Enrollment ID | O20200609001292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225650468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mansoor Kazi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689004996 PECOS PAC ID: 0345498820 Enrollment ID: I20140728002295 |
| Provider Name | Lashandra D Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376900746 PECOS PAC ID: 5092010397 Enrollment ID: I20160224002261 |
| Provider Name | Bilal Mustafa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356661185 PECOS PAC ID: 1557587607 Enrollment ID: I20161207000154 |
| Provider Name | Muhammad Ali Siddiqui |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437125481 PECOS PAC ID: 6406898956 Enrollment ID: I20190131001882 |
| Provider Name | Corretta D Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568071504 PECOS PAC ID: 5799197141 Enrollment ID: I20201209001949 |
| Provider Name | Hazel Violan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184355034 PECOS PAC ID: 9638547284 Enrollment ID: I20221201002527 |
| Provider Name | Sharon Myers-tackie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912617663 PECOS PAC ID: 3173997459 Enrollment ID: I20230328002926 |
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