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129 Daycare Rd Livingston TX 77351-0061 | |
| (936) 563-2058 | |
| (936) 563-2731 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 129 Daycare Rd, Livingston, Texas |
| Authorized Official Name and Position | Paula Alec (INTERN HEALTH DIRECTOR) |
| Authorized Official Contact | 9365631525 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
129 Daycare Rd Livingston TX 77351-0061 Ph: (936) 563-2058 | 129 Daycare Rd Livingston TX 77351-0061 Ph: (936) 563-2058 |
| NPI Number | 1619069986 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 11/20/2024 |
| Medicare PECOS PAC ID | 1658546361 |
|---|---|
| Medicare Enrollment ID | O20111208000081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619069986 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Jehanara Ahmed |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1770568495 PECOS PAC ID: 8820017718 Enrollment ID: I20051121000717 |
| Provider Name | Vanessa Vega |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043614209 PECOS PAC ID: 6800321654 Enrollment ID: I20241203001643 |
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