| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2500 S. Hwy 305, Mccamey, Texas |
| Authorized Official Name and Position | Judith A Gulihur (CFO) |
| Authorized Official Contact | 4326528626 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1200 Mc Camey TX 79752-1200 Ph: (432) 652-8626 | 2500 S. Hwy 305 Mccamey TX 79752 Ph: (432) 652-8626 |
| NPI Number | 1255370474 |
|---|---|
| Provider Enumeration Date | 06/05/2006 |
| Last Update Date | 11/12/2013 |
| Medicare PECOS PAC ID | 8628062320 |
|---|---|
| Medicare Enrollment ID | O20160818000264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255370474 | NPI | - | NPPES |
| 063567401 | Medicaid | TX | |
| 063567402 | Medicaid | TX | |
| 111780100 | Other | TX | FIRST CARE-HOSP RHC PHYS |
| 137325 | Other | TX | SUPERIOR-HOSP BASED RHC |
| 00DT94 | Other | TX | BCBS RHC PHYSICIAN |
| 122439 | Other | TX | SUPERIOR-RHC PHYSICIAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 458681 (Texas) | Primary |