| Southern Hospitality By Clover Family Medicine | |
|
255 W Lebanon Ste 106 Frisco TX 75036-3412 | |
| (469) 294-0210 | |
| (877) 370-4339 |
| Full Name | Southern Hospitality By Clover Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 255 W Lebanon Ste 106, Frisco, Texas |
| Authorized Official Name and Position | Victoria Herold (CEO/ PHYSICIAN) |
| Authorized Official Contact | 4692940210 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Hospitality By Clover Family Medicine 255 W Lebanon Ste 106 Frisco TX 75036-3412 Ph: (469) 294-0210 | Southern Hospitality By Clover Family Medicine 255 W Lebanon Ste 106 Frisco TX 75036-3412 Ph: (469) 294-0210 |
| NPI Number | 1053992008 |
|---|---|
| Provider Enumeration Date | 04/20/2021 |
| Last Update Date | 10/30/2023 |
| Medicare PECOS PAC ID | 5991153983 |
|---|---|
| Medicare Enrollment ID | O20231201000986 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053992008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Victoria Herold |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659785830 PECOS PAC ID: 5294023248 Enrollment ID: I20170823000727 |
| Provider Name | Anna Kristin Rusk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629431564 PECOS PAC ID: 2466885272 Enrollment ID: I20191210000904 |
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