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1502 N Avenue K Lamesa TX 79331-3040 | |
(806) 872-3069 | |
(806) 872-2952 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1502 N Avenue K, Lamesa, Texas |
Authorized Official Name and Position | Judith M Madura (CEO) |
Authorized Official Contact | 8068947842 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1000 Fm 300 Levelland TX 79336-6235 Ph: (806) 894-7842 | 1502 N Avenue K Lamesa TX 79331-3040 Ph: (806) 872-3069 |
NPI Number | 1376656207 |
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Provider Enumeration Date | 08/16/2006 |
Last Update Date | 12/29/2023 |
Medicare PECOS PAC ID | 4880505726 |
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Medicare Enrollment ID | O20030918000004 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376656207 | NPI | - | NPPES |
019035701 | Medicaid | TX | |
019049801 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Sandy Delores Reeves |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598498172 PECOS PAC ID: 2365824646 Enrollment ID: I20220803000875 |
Griengsak Chowpaknam Md Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2200 N Bryan Ave, Lamesa, TX 79331 Phone: 806-796-0507 Fax: 806-799-6908 | |