| |
1276 S Peachtree St Jasper TX 75951-4916 | |
(409) 384-5701 | |
(409) 384-4238 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1276 S Peachtree St, Jasper, Texas |
Authorized Official Name and Position | Paul Trevino (PRESIDENT / CEO) |
Authorized Official Contact | 4098997102 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 848060 Dallas TX 75284-8060 Ph: (800) 756-7999 | 1276 S Peachtree St Jasper TX 75951-4916 Ph: (409) 384-5701 |
NPI Number | 1528030285 |
---|---|
Provider Enumeration Date | 02/06/2006 |
Last Update Date | 10/19/2022 |
Medicare PECOS PAC ID | 3476460049 |
---|---|
Medicare Enrollment ID | O20040707000488 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528030285 | NPI | - | NPPES |
137305204 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Texas) | Primary |
Christus Jasper Memorial Hospital Family Practice Center - Jasper Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1276 S Peachtree St, Jasper, TX 75951 Phone: 361-887-9083 | |
Emd Health Centers Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 203b S Main St, Jasper, TX 75951 Phone: 409-224-8289 | |