MEDICARE: DR. NICK S. POMONIS D.O.

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	207Q00000X	Family Medicine Physician	H0730	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1225034168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICK S. POMONIS D.O.

Provider Business Mailing Address
First Line	:	PO BOX 669386
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-9386
Country	:	US
Telephone Number	:	877-896-6474
Fax Number	:	409-883-4440

Provider Business Practice Location Address
First Line	:	3306 RIDGEMONT DR
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-4236
Country	:	US
Telephone Number	:	409-882-0995
Fax Number	:	409-883-4440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	05/20/2024

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