MEDICARE: PATIENT PLACE P.A.

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	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

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

General Provider Information

NPI Number	:	1891741922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATIENT PLACE P.A.

Provider Business Mailing Address
First Line	:	14850 MONTFORT DR STE 181
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-1450
Country	:	US
Telephone Number	:	214-715-6526
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 HOSPITAL DR STE 140
Second Line	:
City	:	CORSICANA
State	:	TX
Zip	:	75110
Country	:	US
Telephone Number	:	903-201-6405
Fax Number	:	903-257-3800

Authorized Official
Title or Position	:	COO
Name	:	JAMES W. BLAMER
Credential	:
Telephone Number	:	214-333-7333

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	05/25/2021

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Directions to “PATIENT PLACE P.A. ” Practice Location

Language	Start Address	Practice Location

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