| Illuminate Medical Group Pllc | |
|
1028 Truman Rd Lantana TX 76226-4395 | |
| (940) 220-9996 | |
| Not Available |
| Full Name | Illuminate Medical Group Pllc |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 1028 Truman Rd, Lantana, Texas |
| Authorized Official Name and Position | Matthew B Roberson (OWNER / CEO) |
| Authorized Official Contact | 9402209996 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illuminate Medical Group Pllc 1028 Truman Rd Lantana TX 76226-4395 Ph: (940) 220-9996 | Illuminate Medical Group Pllc 1028 Truman Rd Lantana TX 76226-4395 Ph: (940) 220-9996 |
| NPI Number | 1679036891 |
|---|---|
| Provider Enumeration Date | 04/14/2019 |
| Last Update Date | 04/14/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679036891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
S & J Argyle Pharmacy Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 101 Old Town Blvd S, Suite 102, Lantana, TX 76226 Phone: 940-464-4500 Fax: 940-464-4533 |