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2112 Hwy 1431 Kingsland TX 78639-6010 | |
(325) 388-3515 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Rural Health |
Location | 2112 Hwy 1431, Kingsland, Texas |
Authorized Official Name and Position | Kevin A Leeper (CEO) |
Authorized Official Contact | 3252477868 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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200 W Ollie St Llano TX 78643-2628 Ph: (325) 247-5040 | 2112 Hwy 1431 Kingsland TX 78639-6010 Ph: (325) 388-3515 |
NPI Number | 1033191655 |
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Provider Enumeration Date | 11/18/2005 |
Last Update Date | 04/29/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033191655 | NPI | - | NPPES |
00298K | Other | TX | BCBS |
063569001 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 000476 (Texas) | Primary |