|
| |
|
708 Second Street P.o. 727 Hart TX 79043 | |
| (806) 938-2299 | |
| (806) 938-2299 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 708 Second Street, Hart, Texas |
| Authorized Official Name and Position | Retta Knox (PROGRAM DIRECTOR) |
| Authorized Official Contact | 8069382299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
708 Second Street P.o. Box 727 Hart TX 79043 Ph: (806) 938-2299 | 708 Second Street P.o. 727 Hart TX 79043 Ph: (806) 938-2299 |
| NPI Number | 1215075734 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 11/20/2009 |
| Medicare PECOS PAC ID | 4284772914 |
|---|---|
| Medicare Enrollment ID | O20091117000327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215075734 | NPI | - | NPPES |
| 091324602 | Medicaid | TX | |
| 192116501 | Medicaid | TX | |
| 192116502 | Medicaid | TX | |
| 091324601 | Medicaid | TX | |
| 091324603 | Medicaid | TX | |
| 192116503 | Medicaid | TX |
| Provider Name | Steve B Alley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275617177 PECOS PAC ID: 3072561638 Enrollment ID: I20050110001168 |
| Provider Name | Sidney C. Ontai |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1225240443 PECOS PAC ID: 9436047131 Enrollment ID: I20080129000661 |