Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 204 4th Street, Ganado, Texas |
Authorized Official Name and Position | Brett Kirkham (CEO) |
Authorized Official Contact | 9795436251 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
305 Sandy Corner Rd El Campo TX 77437-9535 Ph: (979) 543-5510 | 204 4th Street Ganado TX 77962 Ph: (361) 771-3311 |
NPI Number | 1194349217 |
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Provider Enumeration Date | 06/04/2020 |
Last Update Date | 12/13/2024 |
Medicare PECOS PAC ID | 6406021765 |
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Medicare Enrollment ID | O20210608003459 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194349217 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
W Sam Williams Jr Md Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 204 South 4th Street, Ganado, TX 77962 Phone: 361-771-3311 Fax: 361-771-3081 | |