| |
1400 College Dr Texarkana TX 75503-3536 | |
(903) 791-1110 | |
(903) 791-9353 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1400 College Dr, Texarkana, Texas |
Authorized Official Name and Position | Carla Roadcap (CEO) |
Authorized Official Contact | 9039273782 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1326 Marshall TX 75671-1326 Ph: (903) 927-3782 | 1400 College Dr Texarkana TX 75503-3536 Ph: (903) 791-1110 |
NPI Number | 1053663690 |
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Provider Enumeration Date | 10/05/2012 |
Last Update Date | 06/13/2024 |
Medicare PECOS PAC ID | 8820038565 |
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Medicare Enrollment ID | O20130109000585 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053663690 | NPI | - | NPPES |
192226202 | Medicaid | TX | |
198049002 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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