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NPI Code Detail

MEDICARE: PALLICARE, INC

MEDICARE: PALLICARE, INC
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
1363LC1500XCommunity Health Nurse Practitioner

General Provider Information

NPI Number : 1316511884
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALLICARE, INC
Provider Business Mailing Address
First Line : 5803 STONERIDGE DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-1461
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5803 STONERIDGE DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-1461
Country : US
Telephone Number : 972-632-9642
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JONATHAN FLUHART
Credential :
Telephone Number : 972-632-9642
Provider Enumeration Date : 05/18/2021
Last Update Date : 05/18/2021

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Directions to “PALLICARE, INC ” Practice Location

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