| Itasca Healing Medical Practice | |
|
223 King St Nacogdoches TX 75961-4421 | |
| (936) 622-0552 | |
| (936) 622-0554 |
| Full Name | Itasca Healing Medical Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 223 King St, Nacogdoches, Texas |
| Authorized Official Name and Position | Suzanna Itasca Fuller (OWNER) |
| Authorized Official Contact | 9362502062 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Itasca Healing Medical Practice 223 King St Nacogdoches TX 75961-4421 Ph: (936) 622-0552 | Itasca Healing Medical Practice 223 King St Nacogdoches TX 75961-4421 Ph: (936) 622-0552 |
| NPI Number | 1023867546 |
|---|---|
| Provider Enumeration Date | 05/16/2024 |
| Last Update Date | 10/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023867546 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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