MEDICARE: CRESCENT PSYCHIATRY PLLC

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
1	2084P0800X	Psychiatry Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB166118	OTHER		MEDICARE ID

General Provider Information

NPI Number	:	1043560642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESCENT PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	2852 GIBRALTAR ST
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-5298
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 HOSPITAL PKWY STE 203
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76022-6930
Country	:	US
Telephone Number	:	817-354-2888
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	SABAHAT FAHEEM
Credential	:	MD
Telephone Number	:	817-354-2888

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	10/30/2012

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