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18220 Fm 1431 Ste D Jonestown TX 78645 | |
(877) 800-5722 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 18220 Fm 1431, Jonestown, Texas |
Authorized Official Name and Position | Jonathan David Calvin (CEO) |
Authorized Official Contact | 5129941933 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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205 E University Ave Ste 200 Georgetown TX 78626-6821 Ph: (877) 800-5722 | 18220 Fm 1431 Ste D Jonestown TX 78645 Ph: (877) 800-5722 |
NPI Number | 1902393499 |
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Provider Enumeration Date | 04/19/2018 |
Last Update Date | 09/18/2023 |
Medicare PECOS PAC ID | 5193709392 |
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Medicare Enrollment ID | O20190218000860 |
Identifier | Type | State | Issuer |
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1902393499 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |