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1411 9th St Wichita Falls TX 76301-4302 | |
| (940) 322-6981 | |
| (940) 322-1907 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1411 9th St, Wichita Falls, Texas |
| Authorized Official Name and Position | Michael Allen Anderson (OWNER) |
| Authorized Official Contact | 9403226981 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1411 9th St Wichita Falls TX 76301-4302 Ph: (940) 322-6981 | 1411 9th St Wichita Falls TX 76301-4302 Ph: (940) 322-6981 |
| NPI Number | 1568529477 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 09/17/2008 |
| Medicare PECOS PAC ID | 9739252495 |
|---|---|
| Medicare Enrollment ID | O20080715000080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568529477 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | L5975 (Texas) | Primary |
| Provider Name | Michael A Anderson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669556056 PECOS PAC ID: 6507811825 Enrollment ID: I20050318000543 |
| Provider Name | Thomas J Cleary |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952300162 PECOS PAC ID: 2466525407 Enrollment ID: I20080723000733 |
| Provider Name | Diane Sheree Eakins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841765872 PECOS PAC ID: 1254752090 Enrollment ID: I20200602002047 |
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