| Your Clinic | |
|
1141 Kinwest Pkwy Suite 100 Irving TX 75063-0100 | |
| (214) 239-2222 | |
| (214) 239-2223 |
| Full Name | Your Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1141 Kinwest Pkwy, Irving, Texas |
| Authorized Official Name and Position | Enid S Romanelli (PRESIDENT) |
| Authorized Official Contact | 2142392222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Clinic 1141 Kinwest Pkwy Suite 100 Irving TX 75063-0100 Ph: (214) 239-2222 | Your Clinic 1141 Kinwest Pkwy Suite 100 Irving TX 75063-0100 Ph: (214) 239-2222 |
| NPI Number | 1033230925 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 02/04/2020 |
| Medicare PECOS PAC ID | 7315920014 |
|---|---|
| Medicare Enrollment ID | O20040612000047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033230925 | NPI | - | NPPES |
| 1675308-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Enid Samara Romanelli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710903513 PECOS PAC ID: 2769465467 Enrollment ID: I20040612000080 |
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