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123 Ed Schmidt Blvd Suite 140 Hutto TX 78634-5585 | |
| (877) 800-5722 | |
| (512) 846-2072 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 123 Ed Schmidt Blvd, Hutto, Texas |
| Authorized Official Name and Position | Jonathan David Calvin (CEO) |
| Authorized Official Contact | 5129941933 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
205 E University Ave Suite 200 Georgetown TX 78626-6814 Ph: (512) 868-1124 | 123 Ed Schmidt Blvd Suite 140 Hutto TX 78634-5585 Ph: (877) 800-5722 |
| NPI Number | 1558675488 |
|---|---|
| Provider Enumeration Date | 08/03/2010 |
| Last Update Date | 09/18/2023 |
| Medicare PECOS PAC ID | 5193709392 |
|---|---|
| Medicare Enrollment ID | O20101109001524 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558675488 | NPI | - | NPPES |
| 2134405-02 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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