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14008 Shadowglen Blvd Ste 302 Manor TX 78653-3406 | |
(512) 978-9780 | |
(512) 901-9739 |
Full Name | |
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Speciality | Clinic/Center |
Location | 14008 Shadowglen Blvd Ste 302, Manor, Texas |
Authorized Official Name and Position | Joy Sloan (CFO) |
Authorized Official Contact | 5129789427 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2115 Kramer Ln Austin TX 78758-4013 Ph: () - | 14008 Shadowglen Blvd Ste 302 Manor TX 78653-3406 Ph: (512) 978-9780 |
NPI Number | 1093203713 |
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Provider Enumeration Date | 04/27/2018 |
Last Update Date | 01/24/2024 |
Medicare PECOS PAC ID | 5395802151 |
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Medicare Enrollment ID | O20180615000401 |
Identifier | Type | State | Issuer |
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1093203713 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |