| Jg Nutrend Providers Pa | |
|
425 Holderrieth Blvd Ste 212 Tomball TX 77375-4552 | |
| (346) 246-4171 | |
| Not Available |
| Full Name | Jg Nutrend Providers Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 425 Holderrieth Blvd Ste 212, Tomball, Texas |
| Authorized Official Name and Position | Mary Nan Whitmeyer (PRACTICE MANAGER) |
| Authorized Official Contact | 3462463424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jg Nutrend Providers Pa Po Box 27095 Belfast ME 04915-2022 Ph: (346) 246-4171 | Jg Nutrend Providers Pa 425 Holderrieth Blvd Ste 212 Tomball TX 77375-4552 Ph: (346) 246-4171 |
| NPI Number | 1578185500 |
|---|---|
| Provider Enumeration Date | 05/13/2020 |
| Last Update Date | 03/31/2021 |
| Medicare PECOS PAC ID | 9234560707 |
|---|---|
| Medicare Enrollment ID | O20200518000712 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578185500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QA0005X | Clinic/center - Ambulatory Family Planning Facility | (* (Not Available)) | Secondary |
| Provider Name | John F Gilmore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922180496 PECOS PAC ID: 1951397173 Enrollment ID: I20040423000969 |
| Provider Name | Jennifer Crosby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548301310 PECOS PAC ID: 5193040053 Enrollment ID: I20190426000155 |
| Provider Name | Patricia Joanne Matlock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336264894 PECOS PAC ID: 5991009235 Enrollment ID: I20200214000178 |
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