| Archer K.tullidge Md Pa | |
|
402 Florence St Tomball TX 77375-4622 | |
| (281) 290-8730 | |
| (281) 255-8473 |
| Full Name | Archer K.tullidge Md Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 402 Florence St, Tomball, Texas |
| Authorized Official Name and Position | Archer K Tullidge (OWNER) |
| Authorized Official Contact | 2812908730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Archer K.tullidge Md Pa 402 Florence St Tomball TX 77375-4622 Ph: (281) 290-8730 | Archer K.tullidge Md Pa 402 Florence St Tomball TX 77375-4622 Ph: (281) 290-8730 |
| NPI Number | 1841334414 |
|---|---|
| Provider Enumeration Date | 02/16/2007 |
| Last Update Date | 12/10/2007 |
| Medicare PECOS PAC ID | 0143326512 |
|---|---|
| Medicare Enrollment ID | O20070501000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841334414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | K1944 (Texas) | Primary |
| Provider Name | Archer K Tullidge |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043361926 PECOS PAC ID: 6305942772 Enrollment ID: I20120419000386 |
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