Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 404 Avenue E, Moody, Texas |
Authorized Official Name and Position | Kara Michelle Cox (BUSINESS OFFICE MANAGER) |
Authorized Official Contact | 2542483213 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1507 W Main St Gatesville TX 76528-1024 Ph: (254) 865-2166 | 404 Avenue E Moody TX 76557-3579 Ph: (254) 865-2166 |
NPI Number | 1780298547 |
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Provider Enumeration Date | 08/31/2020 |
Last Update Date | 02/05/2021 |
Medicare PECOS PAC ID | 7719886282 |
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Medicare Enrollment ID | O20210408000973 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780298547 | NPI | - | NPPES |
========= | Other | TX | TIN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |