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2112 Regional Medical Dr Ste 1315 Wharton TX 77488-1413 | |
| (979) 245-2008 | |
| (979) 314-7164 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2112 Regional Medical Dr Ste 1315, Wharton, Texas |
| Authorized Official Name and Position | Manuela Luna (PROVIDER ENROLLMENT COORDINATOR) |
| Authorized Official Contact | 9792452008 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
101 Avenue F N Bay City TX 77414-3167 Ph: (979) 245-2008 | 2112 Regional Medical Dr Ste 1315 Wharton TX 77488-1413 Ph: (979) 245-2008 |
| NPI Number | 1023631678 |
|---|---|
| Provider Enumeration Date | 05/18/2020 |
| Last Update Date | 04/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023631678 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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