| |
11 Woodland Park Dr Shepherd TX 77371-6495 | |
(936) 628-1100 | |
(936) 628-1199 |
Full Name | |
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Speciality | Clinic/Center |
Location | 11 Woodland Park Dr, Shepherd, Texas |
Authorized Official Name and Position | Steven Racciato (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2815922224 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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307 N William Barnett Ave Cleveland TX 77327-4061 Ph: (281) 592-2224 | 11 Woodland Park Dr Shepherd TX 77371-6495 Ph: (936) 628-1100 |
NPI Number | 1346472537 |
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Provider Enumeration Date | 08/20/2009 |
Last Update Date | 06/21/2023 |
Medicare PECOS PAC ID | 9739195041 |
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Medicare Enrollment ID | O20100414000652 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346472537 | NPI | - | NPPES |
179566803 | Medicaid | TX | |
0044NH | Other | TX | BLUE CROSS/SHIELD GROUP NUMBER |
179566802 | Medicaid | TX | |
179566801 | Medicaid | TX | |
00W245 | Other | TX | MEDICARE GROUP NUMBER |