MEDICARE: VISAVIS HEALTH CARE MEDICAL GROUP OF TX 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1518779792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISAVIS HEALTH CARE MEDICAL GROUP OF TX PLLC

Provider Business Mailing Address
First Line	:	1481 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 COLLEGE DR
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-4004
Country	:	US
Telephone Number	:	877-210-2373
Fax Number	:

Authorized Official
Title or Position	:	VP PATIENT CARE SERVICES AND SUCCES
Name	:	IRINA YUFFA
Credential	:
Telephone Number	:	877-210-2373

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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