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2828 Cottonwood Ln Temple TX 76502-2500 | |
| (254) 773-8453 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2828 Cottonwood Ln, Temple, Texas |
| Authorized Official Name and Position | Angie Mattingly (MGR PROVIDER ENROLLMENT) |
| Authorized Official Contact | 5026307425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
805 N Whittington Pkwy Louisville KY 40222-7101 Ph: () - | 2828 Cottonwood Ln Temple TX 76502-2500 Ph: (254) 773-8453 |
| NPI Number | 1649672536 |
|---|---|
| Provider Enumeration Date | 09/23/2014 |
| Last Update Date | 10/18/2023 |
| Certification Date | 10/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649672536 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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