| Live Oak Professional Center | |
|
1705 Live Oak St Commerce TX 75428-2551 | |
| (903) 886-8818 | |
| (903) 886-8765 |
| Full Name | Live Oak Professional Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1705 Live Oak St, Commerce, Texas |
| Authorized Official Name and Position | Sue Nixson (OFFICE MANAGER) |
| Authorized Official Contact | 9038868818 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Oak Professional Center 1705 Live Oak St Commerce TX 75428-2551 Ph: (903) 886-8818 | Live Oak Professional Center 1705 Live Oak St Commerce TX 75428-2551 Ph: (903) 886-8818 |
| NPI Number | 1508848029 |
|---|---|
| Provider Enumeration Date | 11/18/2005 |
| Last Update Date | 04/05/2023 |
| Medicare PECOS PAC ID | 0042279846 |
|---|---|
| Medicare Enrollment ID | O20041007000421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508848029 | NPI | - | NPPES |
| 111557802 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | H0803 (Texas) | Secondary |
| 208D00000X | General Practice | K6628 (Texas) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Tamara Diane Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831577311 PECOS PAC ID: 9234432865 Enrollment ID: I20160114001941 |
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