| |
500 Johnson Dr Mc Gregor TX 76657-1441 | |
(254) 313-5200 | |
(254) 313-5299 |
Full Name | |
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Speciality | Clinic/Center |
Location | 500 Johnson Dr, Mc Gregor, Texas |
Authorized Official Name and Position | Annette Ballew (CFO) |
Authorized Official Contact | 2543134282 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1600 Providence Dr Waco TX 76707-2261 Ph: (254) 313-4200 | 500 Johnson Dr Mc Gregor TX 76657-1441 Ph: (254) 313-5200 |
NPI Number | 1306166830 |
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Provider Enumeration Date | 06/07/2010 |
Last Update Date | 07/28/2017 |
Medicare PECOS PAC ID | 1153370242 |
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Medicare Enrollment ID | O20080125000528 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306166830 | NPI | - | NPPES |
289056801 | Medicaid | TX | |
FQ0000676 | Other | TX | MEDICAID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |