Medina Lake Clinic Pa is a medicare enrolled primary clinic (Family Medicine) in Lakehills, Texas. The current practice location for Medina Lake Clinic Pa is 146 Laurel Vista Dr, Lakehills, Texas. For appointments, you can reach them via phone at
(713) 292-6959. The mailing address for Medina Lake Clinic Pa is 146 Laurel Vista Dr, Lakehills, Texas and phone number is (830) 751-3330.
Medina Lake Clinic Pa is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1811274525. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(713) 292-6959.
Primary Care Clinic Profile
| Full Name | Medina Lake Clinic Pa |
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| Speciality | Family Medicine |
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| Location | 146 Laurel Vista Dr, Lakehills, Texas |
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| Authorized Official Name and Position | Shelly Kohlleppel (OWNER) |
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| Authorized Official Contact | 8307513330 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Medina Lake Clinic Pa
146 Laurel Vista Dr
Lakehills
TX 78063-6389
Ph: (830) 751-3330 | Medina Lake Clinic Pa
146 Laurel Vista Dr
Lakehills
TX 78063-6389
Ph: (713) 292-6959 |
NPI Details:
| NPI Number | 1811274525 |
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| Provider Enumeration Date | 11/09/2011 |
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| Last Update Date | 03/13/2012 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 6204093339 |
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| Medicare Enrollment ID | O20120201000580 |
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Medical Identifiers
Medical identifiers for Medina Lake Clinic Pa such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1811274525 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Medina Lake Clinic Pa acts as a billing entity for following providers:
| Provider Name | Shelley R Kohlleppel |
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| Provider Type | Practitioner - Family Practice |
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| Provider Identifiers | NPI Number: 1922255496
PECOS PAC ID: 5395878656
Enrollment ID: I20100806000403 |
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