MEDICARE: PROCARE EMERGENCY PHYSICIANS LAKEWOOD 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	207P00000X	Emergency Medicine Physician
2	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1619712395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE EMERGENCY PHYSICIANS LAKEWOOD PLLC

Provider Business Mailing Address
First Line	:	2703 TELECOM PKWY STE 140A
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3507
Country	:	US
Telephone Number	:	325-277-2460
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 E MOCKINGBIRD LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2602
Country	:	US
Telephone Number	:	214-443-8131
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. MONICA RAMIREZ
Credential	:
Telephone Number	:	325-277-2460

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	01/19/2026

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