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1870 State Hwy 36 Rising Star TX 76471 | |
(254) 879-4900 | |
(254) 879-4991 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1870 State Hwy 36, Rising Star, Texas |
Authorized Official Name and Position | Nikki Stark (DIRECTOR OF CLINIC OPERATIONS) |
Authorized Official Contact | 2548794910 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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10201 Highway 16 Comanche TX 76442-4462 Ph: (254) 879-4900 | 1870 State Hwy 36 Rising Star TX 76471 Ph: (254) 879-4900 |
NPI Number | 1134720931 |
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Provider Enumeration Date | 11/06/2020 |
Last Update Date | 02/22/2021 |
Medicare PECOS PAC ID | 4385552413 |
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Medicare Enrollment ID | O20210520000859 |
Identifier | Type | State | Issuer |
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1134720931 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |