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Lisa Elaine Medwedeff

Internal Medicine

Allopathic & Osteopathic Physicians

5425 W Spring Creek Parkway Suite 210, Plano, TX 75024

PECOS Enrollment

This provider is enrolled in PECOS as LISA MEDWEDEFF.

Based on the most recent information from CMS, provider Lisa Elaine Medwedeff is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 8:18 PM.

Profile Details

Provider ID
1104827799
Provider Type
Individual
Full Name
Medwedeff, Lisa Elaine
Credential
M.D.

Gender
Female
Sole Proprietor
Yes
Enumeration Date
8/3/2005
Last Updated
11/9/2020

Contact Information

Practice Location

5425 W Spring Creek Parkway Suite 210, Plano, TX 75024

(972) 608-3333

(972) 473-7333

Mailing Location

5425 W Spring Creek Parkway Suite 210, Plano, TX 75024

(972) 608-3333

(972) 473-7333

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License K1257 Texas
Code 173000000X	Description Legal Medicine Other Service Providers	License K1257 Texas

Provider Identifiers

ID	Description	Issuer
ID 0299083-01	Description Medicaid	Issuer Unlisted Texas

Lisa Elaine Medwedeff

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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