Provider Demographics
NPI:1649756420
Name:MEDICAL ENVISION,INC.
Entity Type:Organization
Organization Name:MEDICAL ENVISION,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:PASCUAL
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-495-6929
Mailing Address - Street 1:5001 WILLIFORD RD
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-3378
Mailing Address - Country:US
Mailing Address - Phone:214-934-0768
Mailing Address - Fax:
Practice Address - Street 1:5001 WILLIFORD RD
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048
Practice Address - Country:US
Practice Address - Phone:972-495-6929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0869364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG0869Medicaid