Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 123 Busy Bee, Alto, Texas |
Authorized Official Name and Position | Candice Davis (CLINIC SUPERVISOR) |
Authorized Official Contact | 9366420841 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 427 Alto TX 75925-0427 Ph: () - | 123 Busy Bee Alto TX 75925 Ph: (936) 642-0841 |
NPI Number | 1528413820 |
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Provider Enumeration Date | 04/25/2016 |
Last Update Date | 08/22/2022 |
Medicare PECOS PAC ID | 2769750967 |
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Medicare Enrollment ID | O20170612002290 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528413820 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363AM0700X | Physician Assistant - Medical | PA03871 (Texas) | Secondary |