Nicole Renae Bane, | |
1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 | |
(724) 494-0341 | |
(210) 292-7868 |
Full Name | Nicole Renae Bane |
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Gender | Female |
Speciality | Internal Medicine |
Location | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, Texas |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1629480462 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | OT015982 (Pennsylvania) | Secondary |
207R00000X | Internal Medicine | OS018569 (Pennsylvania) | Primary |
Entity Name | St Clair Professional Services Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1427270594 PECOS PAC ID: 4284672742 Enrollment ID: O20050425000590 |
Mailing Address | Practice Location Address |
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Nicole Renae Bane, 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 Ph: () - | Nicole Renae Bane, 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236-5638 Ph: (724) 494-0341 |
Dr. Krista Rc Rokeh, MD, MS Internal Medicine Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-292-5693 Fax: 210-292-7868 | |
Dr. Audra Cochran, MD Internal Medicine Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-292-4278 | |
Dr. Robert M Kruger, MD Internal Medicine Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-6225 Fax: 210-292-7868 | |
Dr. Charles Haller Ii, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-6835 | |
Aneesh Atul Bapodra, Internal Medicine Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-292-7805 Fax: 210-292-7868 | |
Travis Carlos Batts, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop, Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-6225 | |
Daniel Richard Nassery, D.O. Internal Medicine Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-7805 |