| Jacquelene Mitchell Adiele, Md, Pa | |
|
3816 S Clear Creek Rd Suite A Killeen TX 76549-4400 | |
| (254) 200-2748 | |
| (254) 200-2757 |
| Full Name | Jacquelene Mitchell Adiele, Md, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 3816 S Clear Creek Rd, Killeen, Texas |
| Authorized Official Name and Position | Jacquelene Mitchell Adiele (OWNER) |
| Authorized Official Contact | 2543711172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacquelene Mitchell Adiele, Md, Pa Po Box 938 Killeen TX 76540-0938 Ph: (254) 634-6999 | Jacquelene Mitchell Adiele, Md, Pa 3816 S Clear Creek Rd Suite A Killeen TX 76549-4400 Ph: (254) 200-2748 |
| NPI Number | 1306106687 |
|---|---|
| Provider Enumeration Date | 05/21/2012 |
| Last Update Date | 12/17/2013 |
| Medicare PECOS PAC ID | 5294981148 |
|---|---|
| Medicare Enrollment ID | O20120808000354 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306106687 | NPI | - | NPPES |
| 1609896497 | Other | NPI (INDIVIDUAL) | |
| 034049902 | Other | TX | MEDICAID (INDIVIDUAL) |
| 306297801 | Other | TX | MEDICAID (GROUP) |
| TXB158052 | Other | TX | MEDICARE (GROUP) |
| 1306106687 | Other | NPI (GROUP) | |
| TXB158053 | Other | TX | MEDICARE (INDIVIDUAL) |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | J2678 (Texas) | Primary |
| Provider Name | Jacquelene Mitchell Adiele |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609896497 PECOS PAC ID: 0446254452 Enrollment ID: I20060906000289 |
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