Provider Demographics
NPI:1700112331
Name:LOUIS E. COSTELLO, M.D., P.A.
Entity Type:Organization
Organization Name:LOUIS E. COSTELLO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-979-7462
Mailing Address - Street 1:190 CIVIC CIR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3424
Mailing Address - Country:US
Mailing Address - Phone:972-436-8591
Mailing Address - Fax:972-221-6609
Practice Address - Street 1:190 CIVIC CIR
Practice Address - Street 2:SUITE 250
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3424
Practice Address - Country:US
Practice Address - Phone:972-436-8591
Practice Address - Fax:972-221-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ19502084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113825702Medicaid
TX00999J3Medicare UPIN