| Chillicothe Family Clinic | |
|
14928 Us Hwy 287 S Chillicothe TX 79225 | |
| (940) 852-5131 | |
| (940) 852-5252 |
| Full Name | Chillicothe Family Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 14928 Us Hwy 287 S, Chillicothe, Texas |
| Authorized Official Name and Position | Karla J Waters (CEO) |
| Authorized Official Contact | 9408525131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chillicothe Family Clinic Po Box 370 Box 370 Chillicothe TX 79225-0370 Ph: (940) 852-5131 | Chillicothe Family Clinic 14928 Us Hwy 287 S Chillicothe TX 79225 Ph: (940) 852-5131 |
| NPI Number | 1548269590 |
|---|---|
| Provider Enumeration Date | 07/20/2005 |
| Last Update Date | 10/14/2024 |
| Medicare PECOS PAC ID | 9537221320 |
|---|---|
| Medicare Enrollment ID | O20120227000794 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548269590 | NPI | - | NPPES |
| 154632701 | Medicaid | TX | |
| 00D13V | Other | TX | CLINIC MEDICARE # |
| 1548269590 | Medicaid | TX | |
| 111624601 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 00D13V (Texas) | Primary |
| 282NC0060X | General Acute Care Hospital - Critical Access | 451326 (Texas) | Secondary |
| Provider Name | Sherry Lynn C Wolf |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215980115 PECOS PAC ID: 8628021813 Enrollment ID: I20050228000927 |
| Provider Name | Kimberly Babb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992252951 PECOS PAC ID: 1456634922 Enrollment ID: I20170207001100 |
| Provider Name | Veronika Jo Bryant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053841163 PECOS PAC ID: 0143595900 Enrollment ID: I20171004000407 |
| Provider Name | Mari Brooke Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356979371 PECOS PAC ID: 0840613105 Enrollment ID: I20200706002508 |
| Provider Name | Amber Elizabeth Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346859378 PECOS PAC ID: 3375961295 Enrollment ID: I20200909002138 |