MEDICARE: MANOR PSYCHIATRY LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1710766233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANOR PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	2200 N A W GRIMES BLVD STE 600
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2745
Country	:	US
Telephone Number	:	316-847-5534
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N A W GRIMES BLVD STE 600
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2745
Country	:	US
Telephone Number	:	316-847-5534
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOHAMMAD JAVED
Credential	:	MD
Telephone Number	:	316-847-5534

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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Directions to “MANOR PSYCHIATRY LLC ” Practice Location

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