MEDICARE: DFW PRIMARY CARE 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	253Z00000X	In Home Supportive Care Agency		TX
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1063835361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DFW PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	2925 SKYWAY CIR N
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3510
Country	:	US
Telephone Number	:	972-639-5838
Fax Number	:	972-791-8211

Provider Business Practice Location Address
First Line	:	2925 SKYWAY CIR N
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3510
Country	:	US
Telephone Number	:	972-639-5838
Fax Number	:	972-791-8211

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUMANA KETHA
Credential	:	MD
Telephone Number	:	972-639-5838

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	02/04/2020

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Directions to “DFW PRIMARY CARE PLLC ” Practice Location

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