Individual ProviderVijayendra MishraAnesthesiologyAllopathic & Osteopathic PhysiciansPractice Address12222 Merit Dr Ste 600, Dallas, TX 75251-3294(972) 715-5000(972) 233-1999PECOS EnrollmentBased on the most recent information from CMS, provider Vijayendra Mishra is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1093059040Provider TypeIndividualFull NameMishra, VijayendraCredentialMDGenderMaleSole ProprietorNoEnumeration Date11/15/2012Last Updated8/9/2022Contact InformationPractice LocationPractice Address12222 Merit Dr Ste 600, Dallas, TX 75251-3294Phone(972) 715-5000Fax(972) 715-9976Mailing LocationMailing AddressPO Box 840853, Dallas, TX 75284-0853Phone(972) 233-1999Fax(972) 233-3666Provider TaxonomiesCodeDescriptionLicenseCode207L00000XPrimaryDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicenseR6629TexasCode207L00000XDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicense53831ConnecticutCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerMichigan