Everly Provider Group Ks, P.a. | |
823 Congress Ave Ste 1200 Austin TX 78701-2402 | |
(855) 422-3855 | |
Not Available |
Full Name | Everly Provider Group Ks, P.a. |
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Speciality | General Practice |
Location | 823 Congress Ave Ste 1200, Austin, Texas |
Authorized Official Name and Position | Brantley Tillman Jolly (OWNER/PRESIDENT) |
Authorized Official Contact | 8554223855 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Everly Provider Group Ks, P.a. 823 Congress Ave Ste 1200 Austin TX 78701-2402 Ph: () - | Everly Provider Group Ks, P.a. 823 Congress Ave Ste 1200 Austin TX 78701-2402 Ph: (855) 422-3855 |
NPI Number | 1154185601 |
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Provider Enumeration Date | 02/06/2024 |
Last Update Date | 06/03/2024 |
Medicare PECOS PAC ID | 3870031925 |
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Medicare Enrollment ID | O20240820002832 |
Identifier | Type | State | Issuer |
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1154185601 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Akayla Dawntress Robinson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1700178720 PECOS PAC ID: 4385865229 Enrollment ID: I20141018000109 |
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