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1013a South Wells Street Edna TX 77957-4045 | |
| (361) 782-3560 | |
| (361) 782-5627 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1013a South Wells Street, Edna, Texas |
| Authorized Official Name and Position | Lance Harrison Smiga (ADMINISTRATOR/CFO) |
| Authorized Official Contact | 3617827800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1013 S Wells Street Edna TX 77957-4098 Ph: (361) 782-7800 | 1013a South Wells Street Edna TX 77957-4045 Ph: (361) 782-3560 |
| NPI Number | 1992748693 |
|---|---|
| Provider Enumeration Date | 06/13/2006 |
| Last Update Date | 05/09/2018 |
| Medicare PECOS PAC ID | 2365423795 |
|---|---|
| Medicare Enrollment ID | O20100521000120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992748693 | NPI | - | NPPES |
| 063595501 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Lake Texana Family Dentistry Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 502 N Wells St, Edna, TX 77957 Phone: 361-782-2223 | |
La Bauve Drug Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 119 E Main St, Edna, TX 77957 Phone: 361-782-3313 |