Itasca Healing Medical Practice in Nacogdoches, TX

Itasca Healing Medical Practice is a medicare enrolled primary clinic (Family Medicine) in Nacogdoches, Texas. The current practice location for Itasca Healing Medical Practice is 223 King St, Nacogdoches, Texas. For appointments, you can reach them via phone at (936) 622-0552. The mailing address for Itasca Healing Medical Practice is 223 King St, Nacogdoches, Texas and phone number is (936) 622-0552.

Itasca Healing Medical Practice is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1023867546. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (936) 622-0552.

Contact Information

	Itasca Healing Medical Practice
	223 King St Nacogdoches TX 75961-4421
	(936) 622-0552
	(936) 622-0554

Map and Direction

Primary Care Clinic Profile

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	Yes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

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 Details:

NPI Number	1023867546
Provider Enumeration Date	05/16/2024
Last Update Date	10/02/2024

Medicare PECOS Information:

Medicare PECOS PAC ID	1759812274
Medicare Enrollment ID	O20241008001000

Medical Identifiers

Medical identifiers for Itasca Healing Medical Practice such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1023867546	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Q00000X	Family Medicine	(* (Not Available))	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Itasca Healing Medical Practice acts as a billing entity for following providers:

Provider Name	Suzanna I Fuller
Provider Type	Practitioner - Nurse Practitioner
Provider Identifiers	NPI Number: 1326504382 PECOS PAC ID: 3274874821 Enrollment ID: I20190408002153

Reviews and Comments

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Itasca Healing Medical Practice - Medicare Primary Care in Nacogdoches, TX