MEDICARE: NORTH EAST HOSPITALIST MANAGEMENT, 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
1	208M00000X	Hospitalist Physician	L7415	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	DF0981	OTHER	TX	RAILROAD MEDICARE

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	36NP	OTHER	TX	TEXAS BLUE CROSS
4	5F660	OTHER	AR	ARKANSAS BLUE CROSS

General Provider Information

NPI Number	:	1457399115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH EAST HOSPITALIST MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	11803 SOUTH FWY STE 201
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-7029
Country	:	US
Telephone Number	:	817-293-4800
Fax Number	:	817-293-4808

Provider Business Practice Location Address
First Line	:	11803 SOUTH FWY STE 201
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-7029
Country	:	US
Telephone Number	:	817-293-4800
Fax Number	:	817-293-4808

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	DR. PRAKASH HEGDE
Credential	:	M.D.
Telephone Number	:	817-293-4800

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	09/25/2014

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