| |
402 Mercer St 402 Mercer St Quanah TX 79252-4026 | |
(940) 663-2795 | |
(940) 663-5149 |
Full Name | |
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Speciality | General Acute Care Hospital |
Location | 402 Mercer St, Quanah, Texas |
Authorized Official Name and Position | Tracy Jean Betts (CFO) |
Authorized Official Contact | 9406632795 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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402 Mercer St Po Box 90 Quanah TX 79252-4026 Ph: (940) 663-2795 | 402 Mercer St 402 Mercer St Quanah TX 79252-4026 Ph: (940) 663-2795 |
NPI Number | 1861510521 |
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Provider Enumeration Date | 03/27/2007 |
Last Update Date | 10/15/2014 |
Medicare PECOS PAC ID | 7113919580 |
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Medicare Enrollment ID | O20040402001267 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861510521 | NPI | - | NPPES |
023961801 | Medicaid | TX | |
121692107 | Medicaid | TX | |
121692106 | Medicaid | TX | |
184188401 | Medicaid | TX | |
091847602 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 000102 (Texas) | Secondary |
282NC0060X | General Acute Care Hospital - Critical Access | 000102 (Texas) | Primary |
Provider Name | Kevin B Lane |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1619979044 PECOS PAC ID: 7113907882 Enrollment ID: I20040722001146 |
Provider Name | Tyson K Schaefer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225275852 PECOS PAC ID: 9436342169 Enrollment ID: I20101026000531 |
Provider Name | Fara Faythe Garza |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841740990 PECOS PAC ID: 0749569903 Enrollment ID: I20161111000896 |
Provider Name | Leslie Michelle Rowland |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720111883 PECOS PAC ID: 4284626052 Enrollment ID: I20161117000042 |
Provider Name | Kimberly Babb |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992252951 PECOS PAC ID: 1456634922 Enrollment ID: I20170207001100 |
Provider Name | Linda Wahl Harris |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508878547 PECOS PAC ID: 8123072014 Enrollment ID: I20180906001518 |
Provider Name | Eric Robert Estrada |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1932631165 PECOS PAC ID: 2668741216 Enrollment ID: I20200701001439 |
Provider Name | Carley Elice Foster Brandon |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043845795 PECOS PAC ID: 5799166864 Enrollment ID: I20220720002852 |
Provider Name | Stormy Smith |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1922629138 PECOS PAC ID: 8426470535 Enrollment ID: I20231004000380 |