Full Name | |
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Speciality | Clinic/Center |
Location | 670 Spur 156, Waskom, Texas |
Authorized Official Name and Position | Rupert Mccormac (PRESIDENT) |
Authorized Official Contact | 8008056989 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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200 E Broad St Ste 300 Greenville SC 29601-2891 Ph: (800) 805-6989 | 670 Spur 156 Waskom TX 75692-9129 Ph: (903) 687-2093 |
NPI Number | 1184036790 |
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Provider Enumeration Date | 06/02/2014 |
Last Update Date | 06/18/2022 |
Certification Date | 11/29/2021 |
Medicare PECOS PAC ID | 6901231919 |
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Medicare Enrollment ID | O20200122001471 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184036790 | NPI | - | NPPES |