Full Name | |
---|---|
Speciality | General Practice |
Location | 200 N Pearl St, Mart, Texas |
Authorized Official Name and Position | Jessica Ford (INTERIM ADMINISTRATOR) |
Authorized Official Contact | 2548033561 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 60 Marlin TX 76661-0060 Ph: (254) 803-3561 | 200 N Pearl St Mart TX 76664-1142 Ph: (254) 803-3561 |
NPI Number | 1659593028 |
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Provider Enumeration Date | 05/03/2007 |
Last Update Date | 06/02/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659593028 | NPI | - | NPPES |
167931801 | Medicaid | TX | |
1679318-01 | Other | TX | PTAN |
167931802 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | E0892 (Texas) | Primary |