| Etmc First Physicians Clinic Van | |
|
113 W Main St Van TX 75790-2883 | |
| (903) 963-8303 | |
| (903) 963-5863 |
| Full Name | Etmc First Physicians Clinic Van |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 113 W Main St, Van, Texas |
| Authorized Official Name and Position | Thomas O'gorman (REGIONAL CFO) |
| Authorized Official Contact | 9039465500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Etmc First Physicians Clinic Van 113 W Main St Van TX 75790-2883 Ph: (903) 963-8303 | Etmc First Physicians Clinic Van 113 W Main St Van TX 75790-2883 Ph: (903) 963-8303 |
| NPI Number | 1134115660 |
|---|---|
| Provider Enumeration Date | 09/20/2005 |
| Last Update Date | 06/14/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134115660 | NPI | - | NPPES |
| 063353901 | Medicaid | TX | |
| 017625701 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Van Health And Wellness, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 488 W. Main Street, Van, TX 75790 Phone: 903-963-6850 |