Port Aransas Medical | |
600 Cut Off Rd Ste 14 Port Aransas TX 78373-4246 | |
(361) 749-1930 | |
(361) 749-1933 |
Full Name | Port Aransas Medical |
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Speciality | Family Medicine |
Location | 600 Cut Off Rd Ste 14, Port Aransas, Texas |
Authorized Official Name and Position | Amber Bequillard (ADMINISTRATOR) |
Authorized Official Contact | 3617491930 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Port Aransas Medical 600 Cut Off Rd Suite 14 Port Aransas TX 78373-4246 Ph: (361) 749-1930 | Port Aransas Medical 600 Cut Off Rd Ste 14 Port Aransas TX 78373-4246 Ph: (361) 749-1930 |
NPI Number | 1134385198 |
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Provider Enumeration Date | 07/30/2008 |
Last Update Date | 05/08/2024 |
Medicare PECOS PAC ID | 1759510985 |
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Medicare Enrollment ID | O20140210000556 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134385198 | NPI | - | NPPES |
1821670-01 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | G8391 (Texas) | Primary |
261QP2300X | Clinic/center - Primary Care | 207P00000X (Texas) | Secondary |
Provider Name | Bruce Russell |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1336134188 PECOS PAC ID: 8022082353 Enrollment ID: I20050607000309 |
Provider Name | Janie Russell |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144411026 PECOS PAC ID: 5890738116 Enrollment ID: I20140729001760 |