Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 1224 Main Street, Matador, Texas |
Authorized Official Name and Position | Mary Liz Brown (PHYSICIAN PRACTICE MANAGER) |
Authorized Official Contact | 8062935113 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2222 W 24th St Plainview TX 79072-1802 Ph: (806) 293-5113 | 1224 Main Street Matador TX 79244 Ph: (806) 347-2641 |
NPI Number | 1699080135 |
---|---|
Provider Enumeration Date | 08/09/2010 |
Last Update Date | 10/14/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699080135 | NPI | - | NPPES |
45-8898 | Other | TX | CMS CERTIFICATION NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |