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NPI Code Detail

MEDICARE: VERICARE, P.C.

MEDICARE: VERICARE, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
2103TC0700XClinical PsychologistTX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CB3582OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053369470
Entity Type Code : Organization
Provider Name (Legal Business Name) : VERICARE, P.C.
Provider Business Mailing Address
First Line : 55 HATCHETTS HILL RD
Second Line :
City : OLD LYME
State : CT
Zip : 06371-1534
Country : US
Telephone Number : 800-370-3652
Fax Number : 877-515-7147
Provider Business Practice Location Address
First Line : 1410 E SANDY LAKE RD
Second Line :
City : COPPELL
State : TX
Zip : 75019-3119
Country : US
Telephone Number : 800-257-8715
Fax Number : 800-819-1655
Authorized Official
Title or Position : DIRECTOR, CREDENTIALING ENROLLMENT
Name : MELISSA KING
Credential :
Telephone Number : 800-370-3651
Provider Enumeration Date : 05/05/2006
Last Update Date : 07/10/2017

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