| Creek Stone Integrated Medical Pllc | |
|
3501 Sw 45th Ave Ste T Amarillo TX 79109-5676 | |
| (806) 355-3000 | |
| (806) 418-2305 |
| Full Name | Creek Stone Integrated Medical Pllc |
|---|---|
| Speciality | General Practice |
| Location | 3501 Sw 45th Ave Ste T, Amarillo, Texas |
| Authorized Official Name and Position | Jeffery Williams (OWNER) |
| Authorized Official Contact | 8063553000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creek Stone Integrated Medical Pllc 3501 Sw 45th Ave Ste T Amarillo TX 79109-5676 Ph: (806) 355-3000 | Creek Stone Integrated Medical Pllc 3501 Sw 45th Ave Ste T Amarillo TX 79109-5676 Ph: (806) 355-3000 |
| NPI Number | 1487222683 |
|---|---|
| Provider Enumeration Date | 06/14/2021 |
| Last Update Date | 06/14/2021 |
| Medicare PECOS PAC ID | 2264820802 |
|---|---|
| Medicare Enrollment ID | O20211101000659 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487222683 | NPI | - | NPPES |
| 1871591909 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jeffery S Williams |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1356365258 PECOS PAC ID: 2860497419 Enrollment ID: I20061003000627 |
| Provider Name | Jason Hathaway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447824404 PECOS PAC ID: 5092104984 Enrollment ID: I20211115002586 |
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