Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 201 E Grant Ave, Morton, Texas |
Authorized Official Name and Position | Kody Kitchens (CEO) |
Authorized Official Contact | 8062665566 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
201 E Grant Ave Morton TX 79346-3444 Ph: (806) 266-5566 | 201 E Grant Ave Morton TX 79346 Ph: (806) 266-5566 |
NPI Number | 1336257518 |
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Provider Enumeration Date | 08/28/2006 |
Last Update Date | 05/29/2024 |
Medicare PECOS PAC ID | 2769391192 |
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Medicare Enrollment ID | O20030305000032 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336257518 | NPI | - | NPPES |
121145004 | Medicaid | TX | |
121145002 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 000159 (Texas) | Primary |