| Cedar Creek Clinic, Llc | |
|
2418 W Main St Gun Barrel City TX 75156-3638 | |
| (903) 713-2000 | |
| (903) 713-2004 |
| Full Name | Cedar Creek Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2418 W Main St, Gun Barrel City, Texas |
| Authorized Official Name and Position | Chelsea Rae Springer (OFFICE MANAGER) |
| Authorized Official Contact | 9037132000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar Creek Clinic, Llc 2418 W Main St Gun Barrel City TX 75156-3638 Ph: (903) 713-2000 | Cedar Creek Clinic, Llc 2418 W Main St Gun Barrel City TX 75156-3638 Ph: (903) 713-2000 |
| NPI Number | 1134539000 |
|---|---|
| Provider Enumeration Date | 05/01/2014 |
| Last Update Date | 02/28/2019 |
| Medicare PECOS PAC ID | 4880811108 |
|---|---|
| Medicare Enrollment ID | O20140811001859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134539000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 636969 (Texas) | Primary |
| Provider Name | Jonathan D Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720097298 PECOS PAC ID: 6800965492 Enrollment ID: I20080522000279 |
| Provider Name | Benjamin C Caldwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194809657 PECOS PAC ID: 8022189380 Enrollment ID: I20080616000076 |
| Provider Name | Krystal Lynn Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992363428 PECOS PAC ID: 4284969338 Enrollment ID: I20190711000666 |
| Provider Name | Brandi Jo Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265095202 PECOS PAC ID: 3779914007 Enrollment ID: I20200520002222 |
| Provider Name | Robert Dale Orr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477282721 PECOS PAC ID: 3870969868 Enrollment ID: I20221017000750 |
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Divine Interventions Nurse Concierge Services, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 718 W Main St, Gun Barrel City, TX 75156 Phone: 903-716-6525 | |
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