Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 203 Hackberry St., Tilden, Texas |
Authorized Official Name and Position | Monty Small (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 8305698940 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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310 W Oaklawn Rd Pleasanton TX 78064-4033 Ph: (830) 569-8940 | 203 Hackberry St. Tilden TX 78072 Ph: (361) 274-3690 |
NPI Number | 1164899472 |
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Provider Enumeration Date | 08/24/2015 |
Last Update Date | 04/11/2022 |
Medicare PECOS PAC ID | 3779579412 |
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Medicare Enrollment ID | O20160203001510 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164899472 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |