| Gilcrease Medical Group | |
|
135 Bunton Creek Rd Ste 102 Kyle TX 78640-5701 | |
| (512) 268-2091 | |
| (512) 268-2190 |
| Full Name | Gilcrease Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 135 Bunton Creek Rd Ste 102, Kyle, Texas |
| Authorized Official Name and Position | Gary L Gilcrease (MD, PRESIDENT, OWNER) |
| Authorized Official Contact | 5122682091 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gilcrease Medical Group 135 Bunton Creek Rd Ste 102 Kyle TX 78640-5701 Ph: (512) 268-2091 | Gilcrease Medical Group 135 Bunton Creek Rd Ste 102 Kyle TX 78640-5701 Ph: (512) 268-2091 |
| NPI Number | 1568654887 |
|---|---|
| Provider Enumeration Date | 08/10/2007 |
| Last Update Date | 02/23/2022 |
| Medicare PECOS PAC ID | 5193768208 |
|---|---|
| Medicare Enrollment ID | O20050608001061 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568654887 | NPI | - | NPPES |
| 144784901 | Medicaid | TX | |
| K9069 | Other | TX | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K9069 (Texas) | Primary |
| Provider Name | Gary L Gilcrease |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427090893 PECOS PAC ID: 9638112741 Enrollment ID: I20120423000737 |
| Provider Name | Stephanie Berry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386915601 PECOS PAC ID: 0345404927 Enrollment ID: I20120611000638 |
| Provider Name | Michele M Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558782920 PECOS PAC ID: 2860623139 Enrollment ID: I20140331000479 |
| Provider Name | Trinh Lecomte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093201568 PECOS PAC ID: 4385980531 Enrollment ID: I20190109002861 |
| Provider Name | Candace Vielma |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1992266241 PECOS PAC ID: 6305189341 Enrollment ID: I20190515001488 |
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