Provider Demographics
NPI:1457399115
Name:NORTH EAST HOSPITALIST MANAGEMENT, INC
Entity Type:Organization
Organization Name:NORTH EAST HOSPITALIST MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-293-4800
Mailing Address - Street 1:11803 SOUTH FWY STE 201
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7029
Mailing Address - Country:US
Mailing Address - Phone:817-293-4800
Mailing Address - Fax:817-293-4808
Practice Address - Street 1:11803 SOUTH FWY STE 201
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7029
Practice Address - Country:US
Practice Address - Phone:817-293-4800
Practice Address - Fax:817-293-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7415208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162179002Medicaid
TX184028201Medicaid
TX36NPOtherTEXAS BLUE CROSS
AR5F660OtherARKANSAS BLUE CROSS
TXDF0981OtherRAILROAD MEDICARE
AR162179002Medicaid