| Crystal Beach Medical Clinic Llc | |
|
955 S. East Rd. Crystal Beach TX 77650-1449 | |
| (409) 454-2543 | |
| (866) 521-5608 |
| Full Name | Crystal Beach Medical Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 955 S. East Rd., Crystal Beach, Texas |
| Authorized Official Name and Position | Bruce Lever Mitchell (MEMBER) |
| Authorized Official Contact | 4094542543 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Beach Medical Clinic Llc Po Box 1449 Crystal Beach TX 77650-1449 Ph: (409) 454-2543 | Crystal Beach Medical Clinic Llc 955 S. East Rd. Crystal Beach TX 77650-1449 Ph: (409) 454-2543 |
| NPI Number | 1114948825 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 01/13/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114948825 | NPI | - | NPPES |
| 182389002 | Medicaid | TX | |
| 182389001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
St. Christopher Medical Clinic, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1698 Highway 87, Crystal Beach, TX 77650 Phone: 409-684-3232 Fax: 409-684-3535 |