| Jackson Medical Clinic Of Ganado Physician Group | |
|
202 S. Third Street Ganado TX 77962-1214 | |
| (361) 771-3571 | |
| (361) 771-3574 |
| Full Name | Jackson Medical Clinic Of Ganado Physician Group |
|---|---|
| Speciality | General Practice |
| Location | 202 S. Third Street, Ganado, Texas |
| Authorized Official Name and Position | Marcella Vana Henke (ADMINISTRATOR/CEO) |
| Authorized Official Contact | 3617825241 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Medical Clinic Of Ganado Physician Group 1013 S Wells St Edna TX 77957-4098 Ph: (361) 782-5241 | Jackson Medical Clinic Of Ganado Physician Group 202 S. Third Street Ganado TX 77962-1214 Ph: (361) 771-3571 |
| NPI Number | 1073696357 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073696357 | NPI | - | NPPES |
| 85627001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
W Sam Williams Jr Md Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 204 South 4th Street, Ganado, TX 77962 Phone: 361-771-3311 Fax: 361-771-3081 | |
Mid Coast Wellcare - Ganado Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 204 4th Street, Ganado, TX 77962 Phone: 361-771-3311 | |
Jackson Medical Clinic Of Ganado Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 202 S Third Street, Ganado, TX 77962 Phone: 361-771-3571 Fax: 361-771-3574 | |
Jackson Medical Clinic Of Ganado Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 202 S Third Street, Ganado, TX 77962 Phone: 361-771-3571 Fax: 361-771-3574 |