Provider Demographics
NPI:1528384070
Name:SKILLED PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:SKILLED PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:SASTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-668-5400
Mailing Address - Street 1:PO BOX 2306
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0042
Mailing Address - Country:US
Mailing Address - Phone:972-668-5400
Mailing Address - Fax:972-668-5401
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:STE. 160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:972-668-5400
Practice Address - Fax:972-668-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214797702Medicaid
TXDQ5280OtherRR MEDICARE
TX214797702Medicaid
TXTXB100585Medicare PIN
TXTXB102582Medicare PIN