MEDICARE: NIRP DALLAS-FORT WORTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RC0000X	Cardiovascular Disease Physician
2	2085R0204X	Vascular & Interventional Radiology Physician
3	2086S0129X	Vascular Surgery Physician
4	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
5	363LA2200X	Adult Health Nurse Practitioner
6	363LF0000X	Family Nurse Practitioner
7	207RI0011X	Interventional Cardiology Physician

General Provider Information

NPI Number	:	1992260277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIRP DALLAS-FORT WORTH PLLC

Provider Business Mailing Address
First Line	:	PO BOX 735863
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-5863
Country	:	US
Telephone Number	:	281-888-8999
Fax Number	:	281-305-4054

Provider Business Practice Location Address
First Line	:	1924 FOREST RIDGE DRIVE
Second Line	:	STE 300
City	:	DALLAS
State	:	TX
Zip	:	76021-8228
Country	:	US
Telephone Number	:	281-888-8999
Fax Number	:	281-305-4054

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ANDREW EKANSH GOMES
Credential	:	MD
Telephone Number	:	281-888-8999

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	07/19/2023

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