| |
506 Texas Highway 37 S Mt Vernon TX 75457-6550 | |
(903) 767-7666 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 506 Texas Highway 37 S, Mt Vernon, Texas |
Authorized Official Name and Position | Jean Woel Latortue (MEDICAL DIRECTOR) |
Authorized Official Contact | 9037677666 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
506 Texas Highway 37 S Mt Vernon TX 75457-6550 Ph: (903) 537-8222 | 506 Texas Highway 37 S Mt Vernon TX 75457-6550 Ph: (903) 767-7666 |
NPI Number | 1699171611 |
---|---|
Provider Enumeration Date | 11/18/2014 |
Last Update Date | 05/20/2024 |
Medicare PECOS PAC ID | 9830417229 |
---|---|
Medicare Enrollment ID | O20150415000895 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699171611 | NPI | - | NPPES |
673934 | Other | MEDICARE | |
349100302 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | M7797 (Texas) | Secondary |
261QR1300X | Clinic/center - Rural Health | (Texas) | Primary |
Provider Name | Jean Woel Latortue |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1780871988 PECOS PAC ID: 9335225754 Enrollment ID: I20080326000384 |
Provider Name | Rebecca Ramsay Bentley |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013472273 PECOS PAC ID: 5294127635 Enrollment ID: I20220118000078 |