| Lake Granbury Internal Medicine & Pediatrics, Pa | |
|
2005 Rockview Drive Granbury TX 76049 | |
| (817) 579-1005 | |
| (817) 579-1093 |
| Full Name | Lake Granbury Internal Medicine & Pediatrics, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 2005 Rockview Drive, Granbury, Texas |
| Authorized Official Name and Position | Penelope A. Jackson (PHYSICIAN/OWNER) |
| Authorized Official Contact | 8175791005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Granbury Internal Medicine & Pediatrics, Pa 2005 Rockview Drive Granbury TX 76049 Ph: (817) 579-1005 | Lake Granbury Internal Medicine & Pediatrics, Pa 2005 Rockview Drive Granbury TX 76049 Ph: (817) 579-1005 |
| NPI Number | 1972608636 |
|---|---|
| Provider Enumeration Date | 09/14/2006 |
| Last Update Date | 04/02/2014 |
| Medicare PECOS PAC ID | 1052417649 |
|---|---|
| Medicare Enrollment ID | O20070427000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972608636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Penelope A Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548240682 PECOS PAC ID: 3678502846 Enrollment ID: I20050808000911 |
Hood Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1308 Paluxy Rd Ste 303e, Granbury, TX 76048 Phone: 817-579-0084 Fax: 817-579-0021 | |
Granbury Internal Medicine Associates, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1318 Paluxy Rd, Granbury, TX 76048 Phone: 817-573-8805 Fax: 817-279-9515 | |
Gastrointestinal & Liver Associates Of North Texas P A Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1314 Paluxy Road, Granbury, TX 76048 Phone: 817-573-9881 Fax: 817-573-7516 | |
Nucardio-heart-center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Hill Blvd, Suite 106, Granbury, TX 76048 Phone: 817-579-7770 | |
Hood Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1322 Paluxy Rd Ste 2, Granbury, TX 76048 Phone: 817-579-1642 | |
Nucardio Heart Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 805 Hill Blvd, Suite 106, Granbury, TX 76048 Phone: 817-579-7770 | |
Pat A. Thomas, D.o., P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 Paluxy Rd, Granbury, TX 76048 Phone: 817-573-4585 Fax: 682-498-8096 |