| |
1417 North 1st St Suite A Haskell TX 79521-0938 | |
(940) 864-2636 | |
(940) 864-3009 |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 1417 North 1st St Suite A, Haskell, Texas |
Authorized Official Name and Position | Charles Wayne Cadenhead (OWNER) |
Authorized Official Contact | 9408642636 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1417 North 1st St Suite A Haskell TX 79521-0938 Ph: (940) 864-2636 | 1417 North 1st St Suite A Haskell TX 79521-0938 Ph: (940) 864-2636 |
NPI Number | 1245491026 |
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Provider Enumeration Date | 06/24/2008 |
Last Update Date | 10/09/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245491026 | NPI | - | NPPES |
063645801 | Medicaid | TX | |
0049RE | Other | TX | BLUE CROSS & BLUE SHIELD |
1225468-01 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | E4241 (Texas) | Primary |